Healthcare Provider Details

I. General information

NPI: 1932198066
Provider Name (Legal Business Name): DAVID ALAN FIELDS PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 SUNSET PL MEMORIAL MEDICAL CENTER
NEILLSVILLE WI
54456-1706
US

IV. Provider business mailing address

216 SUNSET PL MEMORIAL MEDICAL CENTER
NEILLSVILLE WI
54456-1706
US

V. Phone/Fax

Practice location:
  • Phone: 715-743-3101
  • Fax: 715-743-6245
Mailing address:
  • Phone: 715-743-3101
  • Fax: 715-743-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1797
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: