Provider Demographics
NPI:1689069874
Name:DAVIDSON, JOHN ALBERT III (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALBERT
Last Name:DAVIDSON
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:JACK
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:648 LA CANADA ST
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-6720
Mailing Address - Country:US
Mailing Address - Phone:858-414-1441
Mailing Address - Fax:
Practice Address - Street 1:345 F ST STE 100
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2632
Practice Address - Country:US
Practice Address - Phone:619-427-3481
Practice Address - Fax:619-420-7807
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5418213EP1101X, 213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery