Provider Demographics
NPI:1467439273
Name:DAVISON, JAMES WILFORD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WILFORD
Last Name:DAVISON
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:PO BOX 7494
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7494
Mailing Address - Country:US
Mailing Address - Phone:787-718-4063
Mailing Address - Fax:
Practice Address - Street 1:2340 AVE EDUARDO RUBERTE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00732-3201
Practice Address - Country:US
Practice Address - Phone:787-718-4063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR011324207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F50715Medicare UPIN