Individual
DR. PHILIP A DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MEDICAL DOCTOR
Contact information
Practice address
2200 PARK AVE BLDG D, STE 100, PARK CITY, UT 84060-7246
(435) 615-8822
(435) 615-8823
Mailing address
2200 PARK AVE BLDG D, STE 100, PARK CITY, UT 84060-7246
(435) 615-8822
(435) 615-8823
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
ME54865
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18987
BLUE CROSS BLUE SHIELD
FL
01
—
2000016351
RAILROAD MEDICARE
FL
05
—
373524900
—
FL
01
—
4511587
AETNA
FL
01
—
AVMED
258113
FL
Enumeration date
11/17/2005
Last updated
10/01/2012
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