Active NPI
Mark Embrey Davis, DO
- Rheumatology Physician
- Green Bay, WI
National Provider Identifier
1720165772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rheumatology Physician
- License
- 34460
- Practice address
- 2223 Lime Kiln Rd
Suite 1
Green Bay, WI 54311-6213 - Phone
- (920) 430-8120
- Fax
- (920) 430-8122
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rheumatology Physician | 207RR0500X | 34460 | WI | Primary |
Addresses
Primary practice location
2223 Lime Kiln Rd
Suite 1
Green Bay, WI 54311-6213
Mailing address
2223 Lime Kiln Rd
Suite 1
Green Bay, WI 54311-6213
Phone (920) 430-8120
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30059100 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34460 | WI | MD | Rheumatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1284076800000",
"number": "1720165772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2223 LIME KILN RD",
"address_2": "SUITE 1",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543116213",
"telephone_number": "920-430-8120",
"fax_number": "920-430-8122"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2223 LIME KILN RD",
"address_2": "SUITE 1",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543116213",
"telephone_number": "920-430-8120",
"fax_number": "920-430-8122"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MARK",
"middle_name": "EMBREY",
"name_prefix": "Mr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2010-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "207RR0500X",
"taxonomy_group": "",
"desc": "Internal Medicine, Rheumatology",
"state": "WI",
"license": "34460",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30059100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 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.