Individual
DR. JEFFREY PAUL STAVENGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2301 25TH ST S, FARGO, ND 58103-6104
(701) 237-9712
(701) 237-0922
Mailing address
2301 25TH ST S, FARGO, ND 58103-6104
(701) 237-9712
(701) 237-0922
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
28822
MN
207X00000X
Orthopaedic Surgery Physician
Primary
5070
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
16967
—
ND
Enumeration date
05/12/2006
Last updated
05/16/2011
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