Provider Demographics
NPI:1770559510
Name:DAVIDSON, KIMBERLY A (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
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 1:15051 S. TAMIAMI TRAIL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908
Mailing Address - Country:US
Mailing Address - Phone:239-437-8810
Mailing Address - Fax:239-313-2555
Practice Address - Street 1:1015 CROSSPOINTE DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-0930
Practice Address - Country:US
Practice Address - Phone:239-596-9075
Practice Address - Fax:239-596-9076
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92997207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME92997OtherLICENSE
FLME92997OtherLICENSE
FLME92997OtherLICENSE
U4991ZMedicare ID - Type Unspecified