Provider Demographics
NPI:1568564227
Name:DAVIS, RONDA D (MD)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 DERONDA ST
Mailing Address - Street 2:
Mailing Address - City:AMERY
Mailing Address - State:WI
Mailing Address - Zip Code:54001-1412
Mailing Address - Country:US
Mailing Address - Phone:715-268-0070
Mailing Address - Fax:715-268-0071
Practice Address - Street 1:230 DERONDA ST
Practice Address - Street 2:
Practice Address - City:AMERY
Practice Address - State:WI
Practice Address - Zip Code:54001-1412
Practice Address - Country:US
Practice Address - Phone:715-268-0070
Practice Address - Fax:715-268-0071
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI430262084P0800X
UT3460780-12052084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34087400Medicaid
WI34087400Medicaid
H38025Medicare UPIN