Healthcare Provider Details

I. General information

NPI: 1447262027
Provider Name (Legal Business Name): MONICA MAYER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 07/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 COLLEGE DR
NEW TOWN ND
58763-9112
US

IV. Provider business mailing address

1058 COLLEGE DR
NEW TOWN ND
58763-9112
US

V. Phone/Fax

Practice location:
  • Phone: 701-627-4750
  • Fax: 701-627-2910
Mailing address:
  • Phone: 701-627-4750
  • Fax: 701-627-2910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number8153
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: