Basic Information
| Provider Information | |||||||||
| NPI: | 1902852171 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIDSON | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 BROWN SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 361177005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342734159 | ||||||||
| FaxNumber: | 3342734556 | ||||||||
| Practice Location | |||||||||
| Address1: | 4145 CARMICHAEL RD | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | AL | ||||||||
| PostalCode: | 36106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342737000 | ||||||||
| FaxNumber: | 3342732228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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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 | 207RX0202X | 22000 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | 22000 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 142405 | 05 | AL | MEDICAID | 511-25723 | 01 | AL | BCBS OF ALABAMA | OTHER | P01307960 | 01 | AL | RAILROAD MEDICARE | OTHER | 7009037 | 01 | AL | AETNA | OTHER | G82730 | 01 | AL | VIVA HEALTH | OTHER | 12065632 | 01 | AL | MULTIPLAN | OTHER | 102I069827 | 01 | AL | MEDICARE | OTHER |