Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | 12914 | ND |
NPI | 1982693875 |
---|---|
Provider Name | Dr. Chris L Cleveland |
First Address | Fargo, ND 58107-2168 |
Second Address | Fargo, ND 58103-5800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2005 |
Last Update Date | 19/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09727868 | (05) | CO |
18277 | (05) | ND |
18308 | (05) | ND |
N719018 | (02) | ND |