Individual
MR. DAVID FOSSUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
101 MERCURY ST, PIERRE, SD 57501-5672
(605) 891-4839
(605) 612-7251
Mailing address
101 MERCURY ST, PIERRE, SD 57501-5672
(605) 891-4839
(612) 725-1318
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0413
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6826162
—
SD
Enumeration date
05/16/2006
Last updated
03/19/2024
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