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General NPI Number Information
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NPI Number | 1538356985
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Entity Type | Organization
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Legal Business Name | GREEN BAY CHEST AND INFECTIOUS DISEASES SC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 704 S WEBSTER AVE SUITE 102
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City | GREEN BAY
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State | WI
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Zip | 54301-3528
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Country | US
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Telephone | 920-433-7516
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Fax | 920-433-7464
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Provider Business Mailing Address
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Address Line | 704 S WEBSTER AVE SUITE 102
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City | GREEN BAY
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State | WI
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Zip | 54301-3528
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Country | US
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Telephone | 920-433-7516
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Fax | 920-433-7464
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD DALE DAVIS
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Credential | M.D.
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Telephone | 920-433-7516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 30054
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License Number State | WI
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