Provider Demographics
NPI:1356444723
Name:DAVISON, BARRY HERRON (MD)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:HERRON
Last Name:DAVISON
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 1:601 S CLAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119
Mailing Address - Country:US
Mailing Address - Phone:972-875-3495
Mailing Address - Fax:972-878-0728
Practice Address - Street 1:601 S CLAY
Practice Address - Street 2:SUITE 103
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119
Practice Address - Country:US
Practice Address - Phone:972-875-3495
Practice Address - Fax:972-878-0728
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9414208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00H74LOtherBCBS
C15095Medicare UPIN