Fossum, David

Fossum, David is an individual health care provider with primary practice located at 101 Mercury St , Pierre SD 57501-5672. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Fossum, David can be contacted via phone (605) 891-4839.

Contact Information

Primary practice address
101 Mercury St Pierre SD 57501-5672
Phone: (605) 891-4839
Fax: (605) 612-7251
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 0413 South Dakota

Profile Details

NPI number 1992757348
LBN Legal business name Fossum, David
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date May 16th, 2006
Last updated Mar 19th, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992757348 NPPES
South Dakota MEDICAID 6826162

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