Provider Demographics
NPI:1861460974
Name:DAVIS, RICK D (MD)
Entity Type:Individual
Prefix:
First Name:RICK
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:228 S 18TH AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-1000
Mailing Address - Country:US
Mailing Address - Phone:920-236-1605
Mailing Address - Fax:920-236-1628
Practice Address - Street 1:2700 W 9TH AVE
Practice Address - Street 2:STE.11
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7247
Practice Address - Country:US
Practice Address - Phone:920-236-1605
Practice Address - Fax:920-236-1628
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI38209-202085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
41084933956001C231OtherCHAMPUS
41084933956001C231OtherCHAMPUS
MN2417559OtherAMERICAS PPO
MNHP58504OtherHEALTH PARTNERS
MNNA2951046005OtherPREFERRED ONE
G34930Medicare UPIN
MN182232OtherUCARE
41084933956001C231OtherCHAMPUS