Individual
JEFFREY K LYSTAD
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
Mailing address
2301 25TH ST S, FARGO, ND 58103-6104
(701) 237-9712
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
7448
ND
Other
Enumeration date
07/17/2006
Last updated
11/29/2011
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