Healthcare Provider Details

I. General information

NPI: 1396779971
Provider Name (Legal Business Name): ERNESTO YU DY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL RD
BELCOURT ND
58316-0160
US

IV. Provider business mailing address

1 HOSPITAL RD
BELCOURT ND
58316
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-6111
  • Fax: 701-477-8401
Mailing address:
  • Phone: 701-477-6111
  • Fax: 701-477-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35043778D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: