Individual
JONATHAN L DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2000
(701) 234-3813
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-2000
(701) 234-3813
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4339
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13282
—
ND
05
—
921898000
—
MN
Enumeration date
07/18/2006
Last updated
01/18/2012
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