Fred Walbrun, MD

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

22566 Issued in WI

Practice address

1715 Dousman St
Green Bay, WI 54303-3211

Phone

(920) 272-1570

Fax

(920) 431-1823

NPI assigned

Aug 15, 2005

Last updated

Sep 15, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Prevea Regional Services, Inc.

  dba Prevea Regional

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1194748061
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473897600000",
    "number": "1306848700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19070",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543079070",
            "telephone_number": "920-496-4700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 DOUSMAN ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543033211",
            "telephone_number": "920-272-1570",
            "fax_number": "920-431-1823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALBRUN",
        "first_name": "FRED",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-15",
        "last_updated": "2016-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "WI",
            "license": "22566",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Betty Wake, LPN
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1908)
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-1453)
• Wal-Mart Stores East, LP (Vision Center 30-1908)
• Wal-Mart Stores East, LP (Vision Center 30-1453)
• Nicole Walch, MA, LPC-IT
• Brittany Walczyk, DNP, APNP, FNP-BC
• Audrey Mary Waldschmidt, PTA
• Walgreen Co (Walgreens #03133)
• Walgreen Co (Walgreens #05746)

• Geriatric Medicine (Internal Medicine) Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Geriatric Medicine (Internal Medicine) Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.