Healthcare Provider Details

I. General information

NPI: 1710979653
Provider Name (Legal Business Name): DAVID GORDON AFFLECK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N 7TH ST
BISMARCK ND
58501-4436
US

IV. Provider business mailing address

PO BOX 281490
ATLANTA GA
30384-1490
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-6000
  • Fax: 701-323-6249
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number24469
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number3461201205
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number346120-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: