Provider Demographics
NPI:1770516478
Name:BELKNAP, BURTON S (MD)
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:S
Last Name:BELKNAP
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4372207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0300189OtherMEDICA #
NDFS9011015508OtherPREFERRED ONE #
ND0300103OtherMEDICA #
ND75OtherNDBS #
ND829897100Medicaid
ND900329OtherAMERICA'S PPO/ARAZ #
NDHP25705OtherHEALTHPARTNERS #
ND23469OtherSIOUX VALLEY #
NDND200002OtherLHS #
ND141995OtherUCARE#
ND13272Medicaid
ND13272Medicaid
ND0300189OtherMEDICA #
ND13272Medicaid
ND75OtherNDBS #
NDD25750Medicare UPIN