Organization
AVERA ST. LUKE'S
Active
Other names
Cosmetics and Plastic Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
RON L JACOBSON (CEO)
(605) 622-5125
Entity
Organization
Contact information
Practice address
4141 31ST AVE S STE 105, FARGO, ND 58104-8778
(605) 725-5030
(605) 725-5028
Mailing address
PO BOX 1460, ABERDEEN, SD 57402-1460
(605) 725-5030
(605) 725-5028
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
10525
SD
Other
Enumeration date
02/03/2011
Last updated
06/30/2011
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