MEDICARE: EDMUND DAVIDSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME27666	FL

General Provider Information

NPI Number	:	1831134006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDMUND DAVIDSON MD

Provider Business Mailing Address
First Line	:	5700 LAKE WORTH RD
Second Line	:	#204
City	:	LAKE WORTH
State	:	FL
Zip	:	33463
Country	:	US
Telephone Number	:	561-968-7968
Fax Number	:	561-964-4603

Provider Business Practice Location Address
First Line	:	3918 VIA POINCIANA
Second Line	:	#8
City	:	LAKE WORTH
State	:	FL
Zip	:	33462
Country	:	US
Telephone Number	:	561-964-3700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	10/03/2007

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