Healthcare Provider Details

I. General information

NPI: 1134176779
Provider Name (Legal Business Name): ROXANNE LYNN JONAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

3276 10TH ST N
FARGO ND
58102-1308
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3241
  • Fax: 701-237-2571
Mailing address:
  • Phone: 218-779-9927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9093
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: