Active NPI
Leo Warren Davidson, MD
- Surgery Physician
- Fayetteville, NC
National Provider Identifier
1235125618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 35312
- Practice address
- 1841 Quiet CV
Fayetteville, NC 28304-3985 - Phone
- (910) 829-6588
- Fax
- (910) 829-6596
- NPI assigned
- Sep 21, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 35312 | NC | Primary |
Addresses
Primary practice location
1841 Quiet CV
Fayetteville, NC 28304-3985
Mailing address
1841 Quiet CV
P O Box 64367
Fayetteville, NC 28304-3985
Phone (910) 323-2626
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020031637 | Other | NC | MEDICARE RAIL ROAD |
| 47806 | Other | NC | MED COST |
| 1738882 | Other | NC | UNITED HEALTH CARE |
| 27271 | Other | NC | BLUE CROSS BLUE SHIELD |
| 8927271 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35312 | NC | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1266451200000",
"number": "1235125618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1841 QUIET CV",
"address_2": "P O BOX 64367",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043985",
"telephone_number": "910-323-2626",
"fax_number": "910-829-6596"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1841 QUIET CV",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043985",
"telephone_number": "910-829-6588",
"fax_number": "910-829-6596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIDSON",
"first_name": "LEO",
"middle_name": "WARREN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-21",
"last_updated": "2010-02-18",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "35312",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAIL ROAD",
"identifier": "020031637",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MED COST",
"identifier": "47806",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "1738882",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "27271",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8927271",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.