JONATHAN L DICKSON (NPI# 1063430619) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1063430619 |
Entity Type | Individual |
Full Name | JONATHAN L DICKSON |
Credential | MD |
Practice Address |
801 Broadway N Fargo ND 58102-3641 |
Practice Telephone | 7012342000 |
Practice Fax Number | 7012343813 |
Mailing Telephone | 7012342000 |
Mailing Fax Number | 7012343813 |
Enumeration Date | 2006-07-18 |
Last Update Date | 2012-01-18 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
4339 | ND | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MN | 921898000 | 05 | |
ND | 13282 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1487110474 | Jonathan David Dickson | Physician Assistant | 627 Turtle Creek Dr, Tyler, TX 75701-1832 | 2019-02-14 |
1629398425 | Jonathan Munger Dickson | Dentist | 6588 E Main St, Farmington, NM 87402-5122 | 2010-06-03 |
Street Address |
801 BROADWAY N |
City | FARGO |
State | ND |
Zip Code | 58102-3641 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528062924 | Mark F Fisher | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2005-06-13 |
1942809652 | Morgan Margaret Borud | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-10-22 |
1790392462 | Katie Thielges | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-09-28 |
1063022432 | Lindsey Schmidt | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-07-31 |
1336766161 | Yesha Shukla | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-27 |
1891310850 | Samantha Mimi Chang | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-15 |
1528683224 | Briana Lee Gebert-oberle | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-09 |
1689296931 | Jillian Virginia Schommer | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-05-09 |
1194344036 | Sarah Rose Carpenter | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-04-10 |
1346871258 | Randall Hagemeister | Nurse Anesthetist, Certified Registered | 801 Broadway N, Fargo, ND 58102-3641 | 2020-01-29 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
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Taxonomy Code | 207RC0000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Internal Medicine |
Specialization | Cardiovascular Disease |
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1841245743 | Larry Steven Sidaway | Internal Medicine | 3000 32nd Avenue South, Essentia Health 32nd Avenue Clinic, Fargo, ND 58103-6132 | 2006-05-23 |
1841550357 | Oludamilola Wuraola Oluleye | Internal Medicine | 3000 32nd Ave South, Fargo, ND 58103 | 2012-05-18 |
1497872675 | Jaise Thekkan Poulose | Internal Medicine | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2007-03-23 |
1861575573 | Ralph Enrique Morales | Internal Medicine | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2006-10-24 |
1376565960 | Joshua Wynne | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-24 |
1134140353 | Wallace E Radtke | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-22 |
1871511436 | Craig R Kouba | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
1932127537 | Christopher L Pierce | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
1063430791 | David J Clardy | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
1437176906 | Manuel R Otero-cagide | Internal Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-17 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.