Individual ProviderLeo Warren DavidsonSurgeryAllopathic & Osteopathic PhysiciansPractice Address1841 Quiet Cv, Fayetteville, NC 28304-3985(910) 829-6588(910) 323-2626PECOS EnrollmentBased on the most recent information from CMS, provider Leo Warren Davidson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1235125618Provider TypeIndividualFull NameDavidson, Leo WarrenCredentialMDGenderMaleSole ProprietorYesEnumeration Date9/21/2005Last Updated2/18/2010Contact InformationPractice LocationPractice Address1841 Quiet Cv, Fayetteville, NC 28304-3985Phone(910) 829-6588Fax(910) 829-6596Mailing LocationMailing Address1841 Quiet Cv, P O Box 64367, Fayetteville, NC 28304-3985Phone(910) 323-2626Fax(910) 829-6596Provider TaxonomiesCodeDescriptionLicenseCode208600000XPrimaryDescriptionSurgeryAllopathic & Osteopathic PhysiciansLicense35312North CarolinaProvider IdentifiersIDDescriptionIssuerID020031637DescriptionOtherIssuerMEDICARE RAIL ROADNorth CarolinaID47806DescriptionOtherIssuerMED COSTNorth CarolinaID1738882DescriptionOtherIssuerUNITED HEALTH CARENorth CarolinaID27271DescriptionOtherIssuerBLUE CROSS BLUE SHIELDNorth CarolinaID8927271DescriptionMedicaidIssuerUnlistedNorth Carolina