Individual
JAMES RILEY DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 S MAIN ST, TIPTON, IN 46072-9753
(765) 675-8391
(765) 675-6704
Mailing address
250 N SHADELAND AVE, SUITE 130, PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01054498A
IN
207P00000X
Emergency Medicine Physician
Primary
12137
MT
207P00000X
Emergency Medicine Physician
M9214
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000851775
ANTHEM PIN
IN
05
—
0259647
—
OH
05
—
200377830
—
IN
05
—
807143000
—
ID
Enumeration date
05/31/2006
Last updated
12/11/2025
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