Brock Madsen Davis, DO

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

253319 Issued in AK

Practice address

254 N Binkley St
Soldotna, AK 99669-7522

Phone

(907) 714-5930

NPI assigned

May 31, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787788800000",
    "number": "1548909534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 HOSPITAL PL",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697559",
            "telephone_number": "907-714-5930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 N BINKLEY ST",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996697522",
            "telephone_number": "907-714-5930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BROCK",
        "middle_name": "MADSEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-31",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "AK",
            "license": "253319",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "AK",
            "license": "253319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bdavis4436120@ak.providencedirect.org",
            "affiliation": "N",
            "endpointDescription": "Central Peninsula Dermatology",
            "address_1": "254 N Binkley St",
            "city": "Soldotna",
            "state": "AK",
            "country_code": "US",
            "postal_code": "996697522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Matthew Meador Dammeyer, PH.D.
• Kymberly Ann Danie'R
• Maia S Danielson, MD
• Catherine A Daro, OTR-L
• Lavern R Davidhizar, DO
• Lynelle CC Davis
• Merab Anne Davis, LMT
• Molly Gretchen Davis, LPC, MAC
• Amy Dawn-Day, LPC
• Amanda M Day-Bontly

• Dermatology Physician in Soldotna, AK
• Providers in Soldotna, AK by specialty
• Dermatology Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2026; 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.