Provider Demographics
NPI:1326434770
Name:DAVIDSON, IYOOH UCHECHUWU (MD)
Entity Type:Individual
Prefix:
First Name:IYOOH UCHECHUWU
Middle Name:
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 1:6020 W PARKER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8172
Mailing Address - Country:US
Mailing Address - Phone:972-608-5000
Mailing Address - Fax:
Practice Address - Street 1:1650 W ROSEDALE ST STE 301
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-7400
Practice Address - Country:US
Practice Address - Phone:682-610-5670
Practice Address - Fax:817-348-0087
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT0762207XS0117X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT0762OtherTMB