Provider Demographics
NPI:1891350039
Name:FIELDS, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FIELDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13322 EXECUTIVE ACRES RD
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-5267
Mailing Address - Country:US
Mailing Address - Phone:210-418-9530
Mailing Address - Fax:
Practice Address - Street 1:1602 AVENUE Q
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-4732
Practice Address - Country:US
Practice Address - Phone:888-264-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN78209207Q00000X
TXT9681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine