Provider Demographics
NPI:1760534762
Name:DAVIDSON, MAURICE (DO)
Entity Type:Individual
Prefix:
First Name:MAURICE
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7560 E PLACITA VENTANA HAYES
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-6269
Mailing Address - Country:US
Mailing Address - Phone:520-299-1159
Mailing Address - Fax:
Practice Address - Street 1:7560 E PLACITA VENTANA HAYES
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750-6269
Practice Address - Country:US
Practice Address - Phone:520-299-1159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18192085R0202X
MI51010053492085R0202X
CA20A42122085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ224444Medicaid
AZ30WCGZT08Medicare PIN