Individual
JON E DORNACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
437 3RD AVE SE, GARRISON, ND 58540-0009
(701) 463-2245
(701) 463-6543
Mailing address
437 3RD AVE SE, PO BOX 09, GARRISON, ND 58540-7235
(701) 337-6714
(701) 463-6543
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
9819
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13921
—
ND
01
—
27263
BLUE CROSS/ BLUE SHIELD
ND
Enumeration date
08/04/2006
Last updated
10/11/2007
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