Provider Demographics
NPI:1063418838
Name:DAVIDSON, CRAIG J (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1232 UNIVERSITY OF OREGON
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1232
Mailing Address - Country:US
Mailing Address - Phone:541-346-0565
Mailing Address - Fax:541-346-2748
Practice Address - Street 1:1232 UNIVERSITY OF OREGON
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1232
Practice Address - Country:US
Practice Address - Phone:541-346-0565
Practice Address - Fax:541-346-2748
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM D28275207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR279253Medicaid
R158802Medicare PIN