Basic Information
| Provider Information | |||||||||
| NPI: | 1063430106 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIDSON | ||||||||
| FirstName: | KERRY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 ROWLAND WAY | ||||||||
| Address2: | STE 215 | ||||||||
| City: | NOVATO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949455011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154933311 | ||||||||
| FaxNumber: | 4154933302 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 BON AIR RD | ||||||||
| Address2: | 3RD FLOOR | ||||||||
| City: | GREENBRAE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949041702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4159257545 | ||||||||
| FaxNumber: | 4159257008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A68562 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.