Free National NPI Number Registry
Jerome Gary Davidson
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NPI Number Detailed Information
Provider Information:
| Name: | Jerome Gary Davidson |
| Gender: | M |
| Provider License Number If Given: | A22489 |
NPI Information:
| NPI: | 1114926490 |
| Entity Type (Individual or Organization): |
1-ind |
| Enumeration Date: | 7/19/2005 |
| Last Update Date: | 6/8/2011 |
Provider Business Mailing Address:
| Address: | PO BOX 11307 San Bernardino, CA 92423 |
| Phone Number: | 8187002336 |
| Fax Number: | 8187002337 |
Provider Business Practice Location Address:
| Address: | 18300 ROSCOE BLVD Northridge, CA 91325 |
| Phone Number: | 8187002336 |
| Fax Number: | 8187002337 |
Provider Taxonomy:
| Primary: | 207RH0003X |
| Secondary (if any): | |
| State: | CA |
