Healthcare Provider Details

I. General information

NPI: 1457387433
Provider Name (Legal Business Name): BRUCE ALLEN VER STEEG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

1112 WESTSIDE DR
FERGUS FALLS MN
56537-2638
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3241
  • Fax: 701-237-2625
Mailing address:
  • Phone: 218-736-6266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28061
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: