Provider Demographics
NPI:1568495398
Name:DAVIDSON, SCOTT DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DAVID
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3600 GASTON AVE
Mailing Address - Street 2:SUITE 1205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1800
Mailing Address - Country:US
Mailing Address - Phone:214-692-8262
Mailing Address - Fax:214-696-4190
Practice Address - Street 1:1600 W COLLEGE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3580
Practice Address - Country:US
Practice Address - Phone:214-826-6021
Practice Address - Fax:214-853-9415
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2017-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXL0783208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164661403Medicaid
TX164661402Medicaid
TX164661403OtherRRMCR
TX164661404Medicaid
TXH34474Medicare UPIN
TX267473YNECMedicare PIN
TX267473YNEDMedicare PIN
TX164661403OtherRRMCR