Individual
JEROME GARY DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
18300 ROSCOE BLVD, NORTHRIDGE, CA 91325-4105
(818) 700-2336
(818) 700-2337
Mailing address
PO BOX 11307, SAN BERNARDINO, CA 92423-1307
(818) 700-2336
(818) 700-2337
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
A22489
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114926490
—
CA
05
—
1902108293
—
CA
05
—
OOA224890
—
CA
Enumeration date
07/19/2005
Last updated
06/08/2011
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