Healthcare Provider Details

I. General information

NPI: 1891350039
Provider Name (Legal Business Name): DAVID FIELDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 S 5TH ST STE A
BRAINERD MN
56401-3574
US

IV. Provider business mailing address

324 S 5TH ST STE A
BRAINERD MN
56401-3574
US

V. Phone/Fax

Practice location:
  • Phone: 218-270-2277
  • Fax: 218-630-1027
Mailing address:
  • Phone: 218-270-2277
  • Fax: 218-630-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT9681
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number78209
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: