Provider Demographics
NPI:1184725715
Name:DAVIDSON, WENDY L (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:L
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1804
Mailing Address - Country:US
Mailing Address - Phone:251-928-8804
Mailing Address - Fax:251-928-8704
Practice Address - Street 1:3 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-928-8804
Practice Address - Fax:251-990-9379
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18319207RS0012X
AL00018319207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009931415Medicaid
AL009931415Medicaid
AL051553844Medicare ID - Type Unspecified