Healthcare Provider Details

I. General information

NPI: 1912620956
Provider Name (Legal Business Name): BRIAN SCOTT VARNER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2022
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 4TH ST S
FARGO ND
58103-1914
US

IV. Provider business mailing address

1200 3RD ST NE
MINNEAPOLIS MN
55413-1104
US

V. Phone/Fax

Practice location:
  • Phone: 918-344-1063
  • Fax:
Mailing address:
  • Phone: 918-344-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberPT24194
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number80793
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: