Jason O Davis (NPI# 1134400385, PAC ID# 7416101464) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1134400385 |
| PAC ID by PECOS | 7416101464 |
| Professional Enrollment ID | I20130129000328 |
| Full Name | Jason O Davis |
| Organization Legal Name | NEW DERMATOLOGY GROUP LTD |
| Address |
3415 Custer St Suite D Manitowoc WI 54220-4328 |
| Phone Number | 9209650345 |
| Gender | M |
| Graduation Year | 2012 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 9537312665 |
| Number of Group Practice Members | 10 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 2500 E Capital Dr, Appleton, WI 54911-8735 | 9205696549 | NEW DERMATOLOGY GROUP LTD |
| 141 Siegler St, Green Bay, WI 54303-2635 | 9209650345 | NEW DERMATOLOGY GROUP LTD |
| 2021 S Webster Ave, Green Bay, WI 54301-2257 | 9209650345 | NEW DERMATOLOGY GROUP LTD |
| 440 Woodward Ave, Iron Mountain, MI 49801-4631 | 9205694970 | NEW DERMATOLOGY GROUP LTD |
| 3415 Custer St, Suite D, Manitowoc, WI 54220-4328 | 9209650345 | NEW DERMATOLOGY GROUP LTD |
| Organization Legal Name | NEW DERMATOLOGY GROUP LTD |
| Physicians | 9 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Kristen M Luikart | Physician Assistant | New Dermatology Group Ltd | 2021 S Webster Ave, Green Bay, WI 54301-2257 |
| David E Orr | Physician Assistant | New Dermatology Group Ltd | 2021 S Webster Ave, Green Bay, WI 54301-2257 |
| Colleen M Van Egeren | Physician Assistant | New Dermatology Group Ltd | 2021 S Webster Ave, Green Bay, WI 54301-2257 |
| Megan M Hotchkiss | Physician Assistant | New Dermatology Group Ltd | 2021 S Webster Ave, Green Bay, WI 54301-2257 |
| Kevan G Lewis | Dermatology | New Dermatology Group Ltd | 2021 S Webster Ave, Green Bay, WI 54301-2257 |
| Rene M Earles | Dermatology | New Dermatology Group Ltd | 2021 S Webster Ave, Green Bay, WI 54301-2257 |
| Kathryn E Vils | Physician Assistant | New Dermatology Group Ltd | 2021 S Webster Ave, Green Bay, WI 54301-2257 |
| Ramona M Hulkonen | Physician Assistant | New Dermatology Group Ltd | 2021 S Webster Ave, Green Bay, WI 54301-2257 |
| Street Address |
3415 CUSTER ST SUITE D |
| City | MANITOWOC |
| State | WI |
| Zip | 54220-4328 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Joshua J Heimerl | Chiropractic | 1632 N 18th St, Manitowoc, WI 54220-1858 | |
| Brenda L Stallbaum | Nurse Practitioner | Holy Family Memorial Inc | 339 Reed Ave, Manitowoc, WI 54220-2020 |
| Mary Beth Reynoso | Clinical Social Worker | Holy Family Memorial Inc | 339 Reed Ave, Manitowoc, WI 54220-2020 |
| Glenda A Mcconnell | Nurse Practitioner | Holy Family Memorial Inc | 339 Reed Ave, Manitowoc, WI 54220-2020 |
| Mylan Kohler | Psychiatry | Holy Family Memorial Inc | 339 Reed Ave, Manitowoc, WI 54220-2020 |
| Callie Schroeder | Psychologist, Clinical | Holy Family Memorial Inc | 339 Reed Ave, Manitowoc, WI 54220-2020 |
| Cameron A Goetz | Psychologist, Clinical | Holy Family Memorial Inc | 339 Reed Ave, Manitowoc, WI 54220-2020 |
| Ellen A Rylander | Clinical Social Worker | Holy Family Memorial Inc | 339 Reed Ave, Manitowoc, WI 54220-2020 |
| Joanna M Smogoleski | Nurse Practitioner | Aurora Medical Group Inc | 601 Reed Ave, Manitowoc, WI 54220-2026 |
| Amber M Schmitz | Nurse Practitioner | Aurora Medical Group Inc | 601 Reed Ave, Manitowoc, WI 54220-2026 |
| Find all physicians in zip 54220 | |||
| City | MANITOWOC |
| Zip Code | 54220 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | MANITOWOC + PHYSICIAN ASSISTANT |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.