Provider Demographics
NPI:1003809641
Name:DAVIDSON, ROBERT CLABAUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLABAUGH
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 W FRYE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5298
Mailing Address - Country:US
Mailing Address - Phone:480-821-1800
Mailing Address - Fax:480-821-6749
Practice Address - Street 1:1727 W FRYE RD STE 220
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5298
Practice Address - Country:US
Practice Address - Phone:480-821-1800
Practice Address - Fax:480-821-6749
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22567207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ0800297OtherUHC
AZ354324Medicaid
AZAZ0381960OtherBCBS