Provider Demographics
NPI:1245258896
Name:DANGERFIELD, JON D (MD)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:D
Last Name:DANGERFIELD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 SHEYENNE ST
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078-2637
Mailing Address - Country:US
Mailing Address - Phone:701-234-4445
Mailing Address - Fax:701-234-4385
Practice Address - Street 1:1220 SHEYENNE ST
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078-2637
Practice Address - Country:US
Practice Address - Phone:701-234-4445
Practice Address - Fax:701-234-4385
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7503207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17850Medicaid
ND18804Medicaid
ND18804Medicaid
G30238Medicare UPIN
NDN15284Medicare PIN