Healthcare Provider Details

I. General information

NPI: 1003067059
Provider Name (Legal Business Name): REGAN M NORGAARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 22ND AVE S
BROOKINGS SD
57006-2830
US

IV. Provider business mailing address

PO BOX 5074
SIOUX FALLS SD
57117-5074
US

V. Phone/Fax

Practice location:
  • Phone: 605-697-1900
  • Fax: 605-697-1919
Mailing address:
  • Phone: 605-328-8395
  • Fax: 605-328-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0675
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: