Provider Demographics
NPI:1982613246
Name:HOVERSON SCHOTT, ALYSSA R (MD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:HOVERSON SCHOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:R
Other - Last Name:HOVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 6002
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58206-6002
Mailing Address - Country:US
Mailing Address - Phone:701-780-5000
Mailing Address - Fax:701-780-1942
Practice Address - Street 1:1000 SOUTH COLUMBIA ROAD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58206-6002
Practice Address - Country:US
Practice Address - Phone:701-780-5000
Practice Address - Fax:701-780-1942
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48913207N00000X
AZ40404207N00000X
ND11319207N00000X
MNMN-48913207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP00610304OtherRAILROAD MEDICARE
AZ350219Medicaid
AZP00624826OtherRAILROAD MEDICARE
MN228673100Medicaid
AZP00624826OtherRAILROAD MEDICARE
MNI61028Medicare UPIN
MN228673100Medicaid