Provider Demographics
NPI:1780629485
Name:DAVISON, JR., DONALD F (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:F
Last Name:DAVISON, JR.
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 6002
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61803-6002
Mailing Address - Country:US
Mailing Address - Phone:217-326-8300
Mailing Address - Fax:
Practice Address - Street 1:602 W.UNIVERSITY AVENUE
Practice Address - Street 2:PEDIATRICS
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801
Practice Address - Country:US
Practice Address - Phone:217-326-1894
Practice Address - Fax:217-383-4468
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082341208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082341Medicaid
ILIL2613OtherMEDICARE GROUP PTAN
0533210001Medicare NSC
ILE58314Medicare UPIN
IL6447860011Medicare NSC
E58314Medicare UPIN
ILIL2613032Medicare PIN
ILIL3270123Medicare PIN
IL036082341Medicaid
ILK37234Medicare PIN