Provider Demographics
NPI:1780353136
Name:BERQUIST, JODY (DVM)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:
Last Name:BERQUIST
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2434
Mailing Address - Country:US
Mailing Address - Phone:218-590-6827
Mailing Address - Fax:
Practice Address - Street 1:1724 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2434
Practice Address - Country:US
Practice Address - Phone:218-590-6827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00698208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI407931OtherWISCONSIN VETERINARY EXAMINING BOARD
MN00698OtherMINNESOTA VETERINARY MEDICINE LICENSING BOARD