Individual
BRUCE DAVISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4855 S MOORLAND RD, NEW BERLIN, WI 53151-7494
(262) 432-7599
(262) 432-7694
Mailing address
5499 STATE ROAD 167, HUBERTUS, WI 53033-9773
(812) 344-4201
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
1036816
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000984523
ANTHEM PIN
IN
05
—
100358660
—
IN
Enumeration date
07/06/2006
Last updated
03/01/2023
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