Healthcare Provider Details

I. General information

NPI: 1902818933
Provider Name (Legal Business Name): J'PATRICK C FAHN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E BROADWAY AVE
BISMARCK ND
58501-4520
US

IV. Provider business mailing address

PO BOX 997
BISMARCK ND
58502-0997
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-7000
  • Fax:
Mailing address:
  • Phone: 701-530-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number9762
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9762
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: