Provider Demographics
NPI:1255651642
Name:DAVIDSON, CLINTON EARL (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:EARL
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ROSE ST # HX315E
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0693
Mailing Address - Country:US
Mailing Address - Phone:859-323-0693
Mailing Address - Fax:859-323-2510
Practice Address - Street 1:UNIVERSITY OF KENTUCKY
Practice Address - Street 2:800 ROSE STREET
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0001
Practice Address - Country:US
Practice Address - Phone:859-323-0693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR31832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology