Healthcare Provider Details

I. General information

NPI: 1043650302
Provider Name (Legal Business Name): AARON ROY ROBERTSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4671 38TH ST S
FARGO ND
58104-7866
US

IV. Provider business mailing address

4671 38TH ST S
FARGO ND
58104-7866
US

V. Phone/Fax

Practice location:
  • Phone: 701-404-5100
  • Fax: 701-499-1166
Mailing address:
  • Phone: 701-404-5100
  • Fax: 701-499-1166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13957
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRL12883
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number13957
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: