Provider Demographics
NPI:1568032670
Name:DAVISON, ROBERT DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DALE
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 27088
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32411-7088
Mailing Address - Country:US
Mailing Address - Phone:850-624-3032
Mailing Address - Fax:
Practice Address - Street 1:1730 COUNTY ROAD 744 UNIT 5
Practice Address - Street 2:
Practice Address - City:ALMONT
Practice Address - State:CO
Practice Address - Zip Code:81210-9709
Practice Address - Country:US
Practice Address - Phone:850-624-3032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00321632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology