Healthcare Provider Details

I. General information

NPI: 1871539304
Provider Name (Legal Business Name): STUART R TOPLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3902 13TH AVE S
FARGO ND
58103-3357
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-6600
  • Fax: 701-364-6628
Mailing address:
  • Phone: 701-364-3300
  • Fax: 701-364-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37840
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7200
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: