Provider Demographics
NPI:1811398365
Name:DRAGON, JOSEPH
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DRAGON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 VALLEY SAGE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84663-3258
Mailing Address - Country:US
Mailing Address - Phone:801-885-2175
Mailing Address - Fax:
Practice Address - Street 1:601 EAST ST N
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:ND
Practice Address - Zip Code:58533-7105
Practice Address - Country:US
Practice Address - Phone:701-584-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001346363LF0000X
NDR40976363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner