Provider Demographics
NPI:1336698471
Name:DAVIDSON, CRAIG L (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
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 1:13001 COUNTY ROAD 10
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55442-1124
Mailing Address - Country:US
Mailing Address - Phone:763-519-2634
Mailing Address - Fax:763-519-2367
Practice Address - Street 1:13001 COUNTY ROAD 10
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55442-1124
Practice Address - Country:US
Practice Address - Phone:763-519-2634
Practice Address - Fax:763-519-2367
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN25974261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health