Provider Demographics
NPI:1619968294
Name:DAVIDSON, ORIN LEONARD III (MD)
Entity Type:Individual
Prefix:DR
First Name:ORIN
Middle Name:LEONARD
Last Name:DAVIDSON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1324 WOLF PARK DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1741
Mailing Address - Country:US
Mailing Address - Phone:901-755-9110
Mailing Address - Fax:901-755-4321
Practice Address - Street 1:1324 WOLF PARK DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1741
Practice Address - Country:US
Practice Address - Phone:901-755-9110
Practice Address - Fax:901-755-4321
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD007594207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB59276Medicare UPIN
TN3160577Medicare ID - Type Unspecified