Provider Demographics
NPI:1912903204
Name:DAVISON, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:DAVISON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13020 N TELECOM PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33637-0925
Mailing Address - Country:US
Mailing Address - Phone:813-978-9700
Mailing Address - Fax:813-972-5055
Practice Address - Street 1:305 E BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5222
Practice Address - Country:US
Practice Address - Phone:813-978-9700
Practice Address - Fax:813-972-5055
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2017-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME34915207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62215OtherBCBS OF FL
FL4251405OtherAETNA
FL200030849OtherRAILROAD MEDICARE
FL225368OtherAVMED
FL274262400Medicaid
FL5227264OtherCIGNA
FL274262400Medicaid
FL62215ZMedicare PIN