Provider Demographics
NPI:1821078841
Name:DAVIDSON, MYRON GY'TON (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRON
Middle Name:GY'TON
Last Name:DAVIDSON
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 1:2500 NE 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1310
Mailing Address - Country:US
Mailing Address - Phone:954-533-5382
Mailing Address - Fax:954-533-8350
Practice Address - Street 1:2500 NE 15TH AVE
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1310
Practice Address - Country:US
Practice Address - Phone:954-533-5382
Practice Address - Fax:954-533-8350
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME92140OtherFLORIDA MEDICAL LICENSE
FLME92140OtherFLORIDA MEDICAL LICENSE