Healthcare Provider Details

I. General information

NPI: 1568769941
Provider Name (Legal Business Name): HANS FJELD JOSEPH D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2011
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 S WASHINGTON ST
GRAND FORKS ND
58201-7245
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201-4183
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-7700
  • Fax: 701-780-6088
Mailing address:
  • Phone: 701-780-4085
  • Fax: 701-780-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS015601
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34.010061
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number13517
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: