Provider Demographics
NPI:1053358465
Name:DAVIDSON, DEANNA D (DO)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:D
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:D
Other - Last Name:HUNTWORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:100 3RD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-9730
Mailing Address - Country:US
Mailing Address - Phone:509-725-7501
Mailing Address - Fax:509-725-7504
Practice Address - Street 1:100 3RD ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-9730
Practice Address - Country:US
Practice Address - Phone:509-725-6560
Practice Address - Fax:509-725-1509
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001498208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACJ6525OtherMEDICARE RAILROAD
WA163959OtherDEPT. OF L & I
WA7101132Medicaid
WA020053407OtherMEDICARE RAILROAD
WA8186389Medicaid
WA8186389Medicaid
BH2090809OtherDEA
F77065Medicare UPIN
WA8186389Medicaid