Healthcare Provider Details

I. General information

NPI: 1245597384
Provider Name (Legal Business Name): TIMOTHY BLAUFUSS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2012
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3284 51ST ST S UNIT 3
FARGO ND
58104-7983
US

IV. Provider business mailing address

3284 51ST ST S UNIT 3
FARGO ND
58104-7983
US

V. Phone/Fax

Practice location:
  • Phone: 701-532-2242
  • Fax: 701-532-2518
Mailing address:
  • Phone: 701-532-2242
  • Fax: 701-532-2518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number64417
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number64417
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number15004
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number15004
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: