Provider Demographics
NPI:1164834289
Name:JOST, JOSHUA (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:JOST
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SANFORD HEALTH
Mailing Address - Street 2:801 BROADWAY N
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58122-0170
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BROADWAY N
Practice Address - Street 2:801
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58122-0170
Practice Address - Country:US
Practice Address - Phone:701-234-5933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND13897207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine