R Dale Davis, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

30054 Issued in WI

Practice address

704 S Webster Ave
Ste 102
Green Bay, WI 54301

Phone

(920) 433-7516

Fax

(920) 433-7464

NPI assigned

Aug 15, 2006

Last updated

Jul 13, 2010By 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

Other identifiers 1

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.

• Green Bay Chest and Infectious Diseases SC

  • Pulmonary Disease Physician
  • Green Bay, WI
  • NPI 1538356985
  NPD (past)

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278979200000",
    "number": "1366455503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "704 S WEBSTER AVE",
            "address_2": "STE 102",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-433-7516",
            "fax_number": "920-433-7464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "704 S WEBSTER AVE",
            "address_2": "STE 102",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54301",
            "telephone_number": "920-433-7516",
            "fax_number": "920-433-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "R",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2010-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WI",
            "license": "30054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31492900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Orrin Davis, PA-C
• Jennifer Davis, M.D.
• Keith Davis, DDS
• Lindsey Davis, SAC-IT 18487-130
• Mark Embrey Davis, DO
• Robert F Davison, MD
• Douglas Dawson, MD
• James R Day, CRNA
• Jacob De Leon
• Maria D De Villa, M.D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2010; 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.