Healthcare Provider Details

I. General information

NPI: 1245258896
Provider Name (Legal Business Name): JON D DANGERFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 SHEYENNE ST
WEST FARGO ND
58078-2637
US

IV. Provider business mailing address

1220 SHEYENNE ST
WEST FARGO ND
58078-2637
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-4445
  • Fax: 701-234-4385
Mailing address:
  • Phone: 701-234-4445
  • Fax: 701-234-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7503
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: