Healthcare Provider Details

I. General information

NPI: 1932127669
Provider Name (Legal Business Name): GREGORY THOMAS BJORKLUND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 1ST AVE S
FARGO ND
58103-1802
US

IV. Provider business mailing address

700 1ST AVE S
FARGO ND
58103-1802
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-4036
  • Fax: 701-234-4160
Mailing address:
  • Phone: 701-234-4036
  • Fax: 701-234-4160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPAC0317
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: