Healthcare Provider Details

I. General information

NPI: 1568754521
Provider Name (Legal Business Name): AARON RICHARD JONES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 08/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 32ND AVE S DEPARTMENT OF RADIOLOGY, ESSENTIA HEALTH
FARGO ND
58103-6132
US

IV. Provider business mailing address

1025 HICKORY LANE WEST
WEST FARGO ND
58078
US

V. Phone/Fax

Practice location:
  • Phone: 701-306-6083
  • Fax:
Mailing address:
  • Phone: 701-306-6083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR-9107
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number60468
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number14013
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: