Provider Demographics
NPI:1255829958
Name:DAVIDSON, ZACHARY (PA-C)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7214 DUNBAR RD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1415
Mailing Address - Country:US
Mailing Address - Phone:419-343-8842
Mailing Address - Fax:
Practice Address - Street 1:2940 N MCCORD RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1753
Practice Address - Country:US
Practice Address - Phone:419-842-3000
Practice Address - Fax:419-291-9883
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MI5601008698363A00000X
OH50.005982RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant