Provider Demographics
NPI:1174528897
Name:DAVIDSON, ALLAN BERNARD (MD)
Entity type:Individual
Prefix:
First Name:ALLAN
Middle Name:BERNARD
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 1:871 OXFORD LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80905-7905
Mailing Address - Country:US
Mailing Address - Phone:719-635-7300
Mailing Address - Fax:719-635-7300
Practice Address - Street 1:871 OXFORD LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80905-7905
Practice Address - Country:US
Practice Address - Phone:719-635-7300
Practice Address - Fax:719-635-7300
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27534207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01275346Medicaid
COA103010Medicare PIN
CO01275346Medicaid
CF9118Medicare PIN
COCC5574Medicare PIN