Provider Demographics
NPI:1982696811
Name:DAVIDSON, MEGAN GOFF (DO)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:GOFF
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:ELIZABETH
Other - Last Name:GOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:130 S 63RD ST
Mailing Address - Street 2:BLDG 3 SUITE 114
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1620
Mailing Address - Country:US
Mailing Address - Phone:480-981-2888
Mailing Address - Fax:480-654-0599
Practice Address - Street 1:130 S 63RD ST
Practice Address - Street 2:BLDG 3 SUITE 114
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1620
Practice Address - Country:US
Practice Address - Phone:480-981-2888
Practice Address - Fax:480-654-0599
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3756207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ898760Medicaid
100437Medicare ID - Type Unspecified
H51508Medicare UPIN