Healthcare Provider Details

I. General information

NPI: 1417397019
Provider Name (Legal Business Name): DANA RIOUX FORKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DANA RIOUX-FORKER

II. Dates (important events)

Enumeration Date: 06/27/2013
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 1ST ST SW
ROCHESTER MN
55905
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 507-284-2511
  • Fax:
Mailing address:
  • Phone: 507-528-4725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2013020688
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number65469
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number65469
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number11805466-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: