Provider Demographics
NPI:1578583191
Name:DAVIDSON, WILLIAM LARRY II (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LARRY
Last Name:DAVIDSON
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7987
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36670-0987
Mailing Address - Country:US
Mailing Address - Phone:251-633-0573
Mailing Address - Fax:251-633-7367
Practice Address - Street 1:8725 COUNTY ROAD 64
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526
Practice Address - Country:US
Practice Address - Phone:251-625-1370
Practice Address - Fax:251-625-1380
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27233207RA0201X, 207K00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051558976OtherMEDICARE
AL1267986OtherCIGNA HC
AL220933Medicaid
AL221413Medicaid
AL2640282OtherUHC
AL212916Medicaid
AL512-05654OtherBCBS
AL7492847OtherAETNA
AL515-41041OtherBCBS
AL512-05653OtherBCBS
ALP00632093OtherRR MEDICARE
MS02277060OtherMS MEDICAID
AL213237Medicaid
AL511-95114OtherBCBS
AL515-91801OtherBCBS
AL9998923Medicaid
ALI151192OtherVIVA HEALTH