Basic Information
| Provider Information | |||||||||
| NPI: | 1578583191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIDSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | LARRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7987 | ||||||||
| Address2: | |||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366700987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516330573 | ||||||||
| FaxNumber: | 2516337367 | ||||||||
| Practice Location | |||||||||
| Address1: | 8725 COUNTY ROAD 64 | ||||||||
| Address2: | |||||||||
| City: | DAPHNE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2516251370 | ||||||||
| FaxNumber: | 2516251380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 06/28/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0201X | 27233 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology | 207K00000X | 27233 | AL | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 051558976 | 01 | AL | MEDICARE | OTHER | 1267986 | 01 | AL | CIGNA HC | OTHER | 220933 | 05 | AL | MEDICAID | 221413 | 05 | AL | MEDICAID | 2640282 | 01 | AL | UHC | OTHER | 212916 | 05 | AL | MEDICAID | 512-05654 | 01 | AL | BCBS | OTHER | 7492847 | 01 | AL | AETNA | OTHER | 515-41041 | 01 | AL | BCBS | OTHER | 512-05653 | 01 | AL | BCBS | OTHER | P00632093 | 01 | AL | RR MEDICARE | OTHER | 02277060 | 01 | MS | MS MEDICAID | OTHER | 213237 | 05 | AL | MEDICAID | 511-95114 | 01 | AL | BCBS | OTHER | 515-91801 | 01 | AL | BCBS | OTHER | 9998923 | 05 | AL | MEDICAID | I151192 | 01 | AL | VIVA HEALTH | OTHER |