Healthcare Provider Details

I. General information

NPI: 1821127036
Provider Name (Legal Business Name): EVANGELINE S. GAID M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 74TH AVE.NE
FT. TOTTEN ND
58335
US

IV. Provider business mailing address

1703 BURKE BLVD
DEVILS LAKE ND
58301-9072
US

V. Phone/Fax

Practice location:
  • Phone: 701-766-1600
  • Fax: 701-766-1726
Mailing address:
  • Phone: 701-766-1600
  • Fax: 701-766-1626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number6062
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: