Provider Demographics
NPI:1437668209
Name:WIDDISON, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WIDDISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5633 B ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-1642
Mailing Address - Country:US
Mailing Address - Phone:907-563-0073
Mailing Address - Fax:907-563-1110
Practice Address - Street 1:5633 B ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1642
Practice Address - Country:US
Practice Address - Phone:907-563-0073
Practice Address - Fax:907-563-1110
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified