Fargo Plastic Surgery PC

Primary specialty

Plastic Surgery PhysicianTaxonomy code 208200000X

License

PT 12481 Issued in ND

Legal business name

FARGO PLASTIC SURGERY PC

Practice address

3280 20TH St S
Fargo, ND 58104-5917

Phone

(701) 293-7480

Fax

(701) 235-2099

NPI assigned

Aug 30, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Peg S Gilbertson

Title

Practice Manager

Phone

(701) 499-4807

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348704000000",
    "number": "1659620110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3280 20TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581045917",
            "telephone_number": "701-293-7480",
            "fax_number": "701-235-2099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3280 20TH ST S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581045917",
            "telephone_number": "701-293-7480",
            "fax_number": "701-235-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARGO PLASTIC SURGERY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-30",
        "last_updated": "2012-09-27",
        "status": "A",
        "authorized_official_last_name": "GILBERTSON",
        "authorized_official_first_name": "PEG",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "701-499-4807"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": "ND",
            "license": "PT 12481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Fargo, ND
• Plastic Surgery Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 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.

Verify at the official NPI Registry.