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Individual

PAUL C DAVIDSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
1250 E MARSHALL ST, SURGERY, RICHMOND, VA 23298-5051
(804) 828-7389
(804) 828-0191
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110003207
VA
363A00000X
Physician Assistant
PA119
DC
363AM0700X
Medical Physician Assistant
PA 1211
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1679564926
HUMANA MEDICARE
VA
05
1679564926
VA
Enumeration date
11/03/2005
Last updated
07/15/2016
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