DR. CORDELL ROSS DAVIS (NPI# 1255592903) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255592903 |
| Entity Type | Individual |
| Full Name | DR. CORDELL ROSS DAVIS |
| Credential | D.O. |
| Practice Address |
4440 S Washington St Grand Forks ND 58201-7245 |
| Mailing Address |
2401 Demers Ave Grand Forks ND 58201-4183 |
| Practice Telephone | 7017327000 |
| Practice Fax Number | 7017327696 |
| Mailing Telephone | 7017804085 |
| Mailing Fax Number | 7017804477 |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2020-06-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 14283 | ND | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 3110 Maccorkle Ave Se, Charleston, WV 253041210 | 3043885590 | 3043888238 |
| Street Address |
4440 S WASHINGTON ST |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201-7245 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497846299 | Brenda K Hanson | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2006-09-27 |
| 1942832456 | Qin Du | Orthopaedic Surgery | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2020-02-12 |
| 1477036374 | Alexandra Webb | Audiologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-09-07 |
| 1538647722 | Rebecca Pulkrabek | Nurse Practitioner | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-07-31 |
| 1083100036 | Nicole Morgan | Nurse Practitioner | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-07-02 |
| 1760984892 | Todd Jensen | Specialist/Technologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2018-03-05 |
| 1093236267 | Agatha J Ottem Lill | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-06-28 |
| 1629519418 | Bennett Leitch | Specialist/Technologist | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-03-14 |
| 1699214387 | Altru Health System | Clinic/Center | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2017-02-15 |
| 1548654585 | Megan Nicole Kipp | Physician Assistant | 4440 S Washington St, Grand Forks, ND 58201-7245 | 2015-03-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1225523004 | Alicia Mae Mack | Registered Nurse | 212 S. 4th St. Suite 301, Spectra Health, Grand Forks, ND 58201 | 2018-06-25 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| Find all providers in zip 58201 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508933144 | Dr Steven Schultz Md PC | Urology | 3375 De Mers Ave, Grand Forks, ND 58201 | 2006-11-29 |
| 1063619237 | Adam Foster Nicholson | Urology | 4440 S Washington St - Altru Professional Center, Grand Forks, ND 58201 | 2007-06-29 |
| 1982789152 | Joseph Kevin Wheatley | Urology | 1000 South Columbia Road, Grand Forks, ND 58206-6002 | 2006-10-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811190465 | Medcenter One Inc | Urology | 12 1st St W, City Center Plaza, Dickinson, ND 58601-5106 | 2007-06-08 |
| 1326178013 | Alan F.h. Lim, M.d., P.C. | Urology | 20 Burdick Expy W Ste 202, Minot, ND 58701-4498 | 2007-03-06 |
| 1912947847 | Robert Allen Pathroff | Urology | 225 North 7th Street, Bismarck, ND 58501 | 2006-06-08 |
| 1578529392 | Salem Shehadeh Shahin | Urology | 1219 Knoll St, Williston, ND 58801 | 2006-04-21 |
| 1255827697 | Karim Courtemanche | Urology | 222 N 7th St, Bismarck, ND 58501-4436 | 2018-07-09 |
| 1831519388 | Archana Rajender | Urology | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2014-04-23 |
| 1295179687 | Eric Andrew Schommer | Urology | 801 Broadway N, Fargo, ND 58102 | 2013-04-29 |
| 1326301250 | Philip M. Wanzek | Urology | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2012-06-15 |
| 1205104080 | Salem S Shahin Md PC | Urology | 1219 Knoll St, Williston, ND 58801-3234 | 2011-12-07 |
| 1750676201 | Cameron M Charchenko | Urology | 900 E Broadway Ave, Bismarck, ND 58501-4520 | 2011-06-13 |
| Find all providers with the same taxonomy | ||||
| City | GRAND FORKS |
| Zip Code | 58201 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.