Provider Demographics
NPI:1356482384
Name:DAVIDSON, RONALD JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAY
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 1:462 N LINDEN DR
Mailing Address - Street 2:SUITE 436
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2247
Mailing Address - Country:US
Mailing Address - Phone:310-271-7176
Mailing Address - Fax:310-271-3460
Practice Address - Street 1:462 N LINDEN DR
Practice Address - Street 2:SUITE 436
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2247
Practice Address - Country:US
Practice Address - Phone:310-271-7176
Practice Address - Fax:310-271-3460
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG312502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91332Medicare UPIN
CAG31250Medicare ID - Type Unspecified