Active NPI
David B Flach, MD
- Dermatology Physician
- Fargo, ND
National Provider Identifier
1316964273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 5202
- Practice address
- 4656 40TH Ave S
Fargo, ND 58104-4397 - Phone
- (701) 234-8860
- Fax
- (701) 234-8924
- NPI assigned
- Jul 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 5202 | ND | Primary |
Addresses
Primary practice location
4656 40TH Ave S
Fargo, ND 58104-4397
Mailing address
4656 40TH Ave S
Fargo, ND 58104-4397
Phone (701) 234-8860
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15187 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5202 | ND | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326844800000",
"number": "1316964273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4656 40TH AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581044397",
"telephone_number": "701-234-8860",
"fax_number": "701-234-8924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4656 40TH AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581044397",
"telephone_number": "701-234-8860",
"fax_number": "701-234-8924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLACH",
"first_name": "DAVID",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-16",
"last_updated": "2012-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "ND",
"license": "5202",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "15187",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.