Provider Demographics
NPI:1932198066
Name:FIELDS, DAVID ALAN (PAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ALAN
Last Name:FIELDS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SUNSET PL
Mailing Address - Street 2:MEMORIAL MEDICAL CENTER
Mailing Address - City:NEILLSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54456-1706
Mailing Address - Country:US
Mailing Address - Phone:715-743-3101
Mailing Address - Fax:715-743-6245
Practice Address - Street 1:216 SUNSET PL
Practice Address - Street 2:MEMORIAL MEDICAL CENTER
Practice Address - City:NEILLSVILLE
Practice Address - State:WI
Practice Address - Zip Code:54456-1706
Practice Address - Country:US
Practice Address - Phone:715-743-3101
Practice Address - Fax:715-743-6245
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1797363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41994200Medicaid
Q12010Medicare UPIN