Individual
GODELA R IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3000 32ND AVE S, FARGO, ND 58103-6132
(701) 364-8000
(701) 364-8078
Mailing address
PO BOX 6001, FARGO, ND 58108-6001
(701) 364-3300
(701) 364-8906
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
28275
MN
207RI0200X
Infectious Disease Physician
Primary
3278
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1022
NDBS #
ND
01
—
10750
NDBS #
ND
05
—
12383
—
ND
01
—
142019
UCARE #
ND
01
—
2580
NDBS #
MN
01
—
4864
NDBS #
ND
01
—
50168IV
MNBS #
MN
01
—
902104
AMERICA'S PPO/ARAZ #
ND
01
—
91481IV
MNBS #
ND
01
—
9200082
MEDICA #
ND
01
—
9200119
MEDICA #
ND
01
—
DA9011015543
PREFERRED ONE #
ND
01
—
HP25778
HEALTHPARTNERS #
ND
01
—
ND200028
LHS #
ND
Enumeration date
07/04/2006
Last updated
07/09/2007
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