Active NPI
Robert F Davison, MD
- Nuclear Imaging & Therapy Physician
- Green Bay, WI
National Provider Identifier
1992749824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nuclear Imaging & Therapy Physician
- License
- 45841
- Practice address
- 2941 S Ridge Rd
Green Bay, WI 54304-5517 - Phone
- (920) 336-4096
- Fax
- (920) 336-8093
- NPI assigned
- Jun 14, 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 |
|---|---|---|---|---|
| Nuclear Imaging & Therapy Physician | 207UN0902X | 45841 | WI | Primary |
Addresses
Primary practice location
2941 S Ridge Rd
Green Bay, WI 54304-5517
Mailing address
2941 S Ridge Rd
Green Bay, WI 54304-5517
Phone (920) 336-4096
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4545625 | 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 Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45841 | WI | MD | Nuclear Imaging & Therapy Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992749824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2941 S RIDGE RD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543045517",
"telephone_number": "920-336-4096",
"fax_number": "920-336-8093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2941 S RIDGE RD",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543045517",
"telephone_number": "920-336-4096",
"fax_number": "920-336-8093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVISON",
"first_name": "ROBERT",
"middle_name": "F",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-14",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207UN0902X",
"taxonomy_group": "",
"desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
"state": "WI",
"license": "45841",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4545625",
"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 Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.