Organization
ROBERT L. DAVIDSON, M.D. PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LANTZ DAVIDSON M.D. (PHYSICIAN OWNER)
(208) 890-9539
Entity
Organization
Contact information
Practice address
520 S EAGLE RD, SUITE 1245, MERIDIAN, ID 83642-6351
(208) 890-2539
(208) 939-2698
Mailing address
13601 W MCMILLAN RD, SUITE 102-311, BOISE, ID 83713-2071
(208) 890-2539
(208) 939-2698
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
M7907
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003661400
—
ID
Enumeration date
12/11/2009
Last updated
12/11/2009
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