Doctor Name: | DR. ROBERT LANTZ DAVIDSON |
NPI Number: | 1144275694 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | M7907 |
Business Practice Address: | 520 S Eagle Rd Suite 1245 Meridian, ID - 836426351 |
Business Phone Number: | 2088902539 |
Business Fax Number: | 2089392698 |
Mailing Address: | 13601 W Mcmillan Rd, Suite 102-311 BOISE |
State: | ID |
Postal Code: | 837132071 |
Phone Number: | 2088902539 |
Fax Number: | 2089392698 |
NPI Enumeration Date: | 05/23/2006 |
NPI Last Update Date: | 12/02/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | M7907 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |