Individual
ALISON DAVISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
405 W JACKSON ST, CARBONDALE, IL 62901-1462
(618) 549-0721
Mailing address
PO BOX 955860, SAINT LOUIS, MO 63195-0126
(636) 498-9444
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
085-001876
IL
363A00000X
Physician Assistant
Primary
085-001876
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1055357
NCCPA
—
01
—
3932056
BLUE SHIELD
IL
Enumeration date
07/12/2006
Last updated
10/19/2020
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