Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 5781 | ND |
NPI | 1811094626 |
---|---|
Provider Name | Scott Turner |
First Address | Fargo, ND 58103-6050 |
Second Address | Fargo, ND 58103-6050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 06/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010042168 | RR MEDICARE (01) | ND |
E46359 | (02) | ND |