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General NPI Number Information
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NPI Number | 1437834256
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Entity Type | Organization
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Legal Business Name | PROGRESS WEIGHT MANAGEMENT PLLC
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 3625 LINCOLN ST S
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City | FARGO
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State | ND
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Zip | 58104-7765
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Country | US
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Telephone | 701-388-3785
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Fax |
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Provider Business Mailing Address
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Address Line | 3625 LINCOLN ST S
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City | FARGO
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State | ND
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Zip | 58104-7765
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Country | US
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Telephone | 701-388-3785
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | CODY BAXTER
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Credential | PA-C
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Telephone | 701-388-3785
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QB0002X
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Taxonomy Name | Obesity Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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