AVERA ST. LUKE'S NPI 1619273927

NPI Information

AVERA ST. LUKE'S is a plastic and reconstructive surgery surgery in Fargo, ND. The provider is a surgeon who specializes in plastic and reconstructive surgery. AVERA ST. LUKE'S NPI is 1619273927. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Cosmetics And Plastic Surgery.

The provider's business location address is:

4141 31ST AVE S STE 105
FARGO, ND
ZIP 58104-778
Phone: (605) 725-5030
Fax: (605) 725-5028

The provider's authorized official is Ron L Jacobson .
The authorized official title is Ceo and has the following contact phone number (605) 622-5125.

The enumeration date for this NPI number is 2/3/2011 and was last updated on 6/30/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

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