Provider Demographics
NPI:1760456412
Name:DAVIDSON, PAUL M (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1241 W MINERAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5685
Mailing Address - Country:US
Mailing Address - Phone:303-759-0854
Mailing Address - Fax:303-759-0864
Practice Address - Street 1:7700 S BROADWAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2602
Practice Address - Country:US
Practice Address - Phone:303-730-5800
Practice Address - Fax:303-730-5868
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2022-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO31240207P00000X
COCDRH.0031240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO930096057OtherRR MEDICARE
CO01312404Medicaid
COF50705Medicare UPIN
CO930096057OtherRR MEDICARE