Healthcare Provider Details

I. General information

NPI: 1811798093
Provider Name (Legal Business Name): DILLON BOEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2025
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W VERNON AVE
FERGUS FALLS MN
56537-2741
US

IV. Provider business mailing address

111 W VERNON AVE
FERGUS FALLS MN
56537-2741
US

V. Phone/Fax

Practice location:
  • Phone: 218-739-2221
  • Fax:
Mailing address:
  • Phone: 218-739-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15385
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: