Jeffrey Paul Stavenger, MD
Individual provider Active NPI Orthopaedic Surgery Physician · Fargo, ND
NPI 1659322865 · NPPES record last updated May 16, 2011
Key facts
- NPI
- 1659322865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- 5070 (ND)
- Practice address
- 2301 25TH St S
Fargo, ND 58103-6104 - Phone
- (701) 237-9712
- Fax
- (701) 237-0922
- NPI assigned
- May 12, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28822 | MN | MD | Orthopaedic Surgery Physician |
| 5070 | ND | MD | Orthopaedic Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | 5070 | ND | Yes |
| Orthopaedic Surgery Physician | 207X00000X | 28822 | MN |
Addresses
Primary practice location
2301 25TH St S
Fargo, ND 58103-6104
Mailing address
2301 25TH St S
Fargo, ND 58103-6104
Phone (701) 237-9712
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16967 | Medicaid | ND |
Other providers in Fargo, ND
- Vitaliy Starosta
- Robert F Startz
- Jessica Staska
- Andrew John Stasko
- Douglas John Stavenger
- Trevor Dennis Stavig
- Kelsey R Stay
- Michael Grant Stearns
- Williams G Stearns
- Christin Saline Stebe
All providers in Fargo, ND · Orthopaedic Surgery Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.