Healthcare Provider Details

I. General information

NPI: 1497772032
Provider Name (Legal Business Name): JAMES G MEHUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 10/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 1ST ST SW
MAYVILLE ND
58257-1518
US

IV. Provider business mailing address

PO BOX 2010
FARGO ND
58122-2484
US

V. Phone/Fax

Practice location:
  • Phone: 701-786-4500
  • Fax: 701-786-4545
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9656
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9656
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: