Robert Davidson, M.D.

Individual provider Active NPI Internal Medicine Physician · Gladewater, TX

NPI 1497869804 · NPPES record last updated Feb 19, 2008

Key facts

NPI
1497869804
Entity type
Individual (NPI type 1)
Primary specialty
Internal Medicine Physician 207R00000X
License
H2328 (TX)
Practice address
307 W Upshur Ave
Gladewater, TX 75647-2121
Phone
(903) 845-2159
Fax
(903) 845-5451
NPI assigned
Aug 19, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Phynet, Inc. Past Accepting new patients
East Texas Treatment Center Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X H2328 TX Yes

Addresses

Primary practice location

307 W Upshur Ave
Gladewater, TX 75647-2121

Mailing address

4002 Technology Ctr
Longview, TX 75605-2697
Phone (903) 247-0484

Other providers in Gladewater, TX

All providers in Gladewater, TX · Internal Medicine Physician in Texas

Sources for this page

Verify at the official NPI Registry.