Organization
FAIRVIEW HEIGHTS MEDICAL GROUP SC
Active
Other names
Alton Urological Associates
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND P DAVIDSON II MD (PRESIDENT)
(314) 286-2028
Entity
Organization
Contact information
Practice address
2 MEMORIAL DR, SUITE 101, ALTON, IL 62002-6723
(618) 462-0720
Mailing address
670 MASON RIDGE CENTER DR, SUITE 300, SAINT LOUIS, MO 63141-8573
(314) 996-7644
(314) 996-7658
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Enumeration date
02/15/2007
Last updated
01/07/2008
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