Individual
DR. JON A. MACHAYYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-6236
Mailing address
801 BROADWAY N, FARGO, ND 58102-3641
(701) 234-6236
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
81060
AZ
2085R0204X
Vascular & Interventional Radiology Physician
Primary
11886
ND
2085R0204X
Vascular & Interventional Radiology Physician
PT 11886
ND
Other
Enumeration date
04/18/2008
Last updated
11/29/2011
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