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Contact Information

PHILIP A DAVIDSON, MEDICAL DOCTOR
2200 PARK AVE BLDG D
STE 100
PARK CITY, UT84060-7246
 Phone: 435-615-8822
 Fax: 435-615-8823
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Sports Medicine

207XX0005X 02 Physician/General Surgery
Indicates primary specialty

NPI Profile & details for PHILIP A DAVIDSON · (Male)

NPI Number 1528040367
Status Active
Credentials MEDICAL DOCTOR
Entity Individual
Enumeration date 11/17/2005
Last updated 10/01/2012 - About 14 years ago
Sole proprietor 1 No
Identifiers
  • FL License # ME54865
  • FL Medicaid 373524900
  • FL Other AVMED 258113
  • FL Other 4511587 AETNA
  • FL Other 18987 BLUE CROSS BLUE SHIELD
  • FL Other 2000016351 RAILROAD MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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