Provider Demographics
NPI:1457551228
Name:BROADWAY, STEVEN JARED (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JARED
Last Name:BROADWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2829 UNIVERSITY DR S STE 202
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6050
Mailing Address - Country:US
Mailing Address - Phone:701-356-7444
Mailing Address - Fax:701-478-0309
Practice Address - Street 1:2829 UNIVERSITY DR S STE 202
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6050
Practice Address - Country:US
Practice Address - Phone:701-356-7444
Practice Address - Fax:701-478-0309
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN53685207T00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program