DR. BRYN PUTBRESE (NPI# 1134462716) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134462716 |
| Entity Type | Individual |
| Full Name | DR. BRYN PUTBRESE |
| Credential | M.D. |
| Practice Address |
801 Broadway N Fargo ND 58102-3641 |
| Mailing Address |
Po Box 2168 Fargo ND 58107-2168 |
| Practice Telephone | 7012342000 |
| Practice Fax Number | 7012342345 |
| Mailing Telephone | 7012342000 |
| Mailing Fax Number | 7012342345 |
| Enumeration Date | 2013-04-01 |
| Last Update Date | 2019-10-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085N0700X |
Radiology Specialization: Neuroradiology |
15653 | ND | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
801 BROADWAY N |
| City | FARGO |
| State | ND |
| Zip Code | 58102-3641 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528062924 | Mark F Fisher | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2005-06-13 |
| 1942809652 | Morgan Margaret Borud | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-10-22 |
| 1790392462 | Katie Thielges | Nurse Practitioner | 801 Broadway N, Fargo, ND 58102-3641 | 2020-09-28 |
| 1063022432 | Lindsey Schmidt | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-07-31 |
| 1336766161 | Yesha Shukla | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-27 |
| 1891310850 | Samantha Mimi Chang | Family Medicine | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-15 |
| 1528683224 | Briana Lee Gebert-oberle | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-06-09 |
| 1689296931 | Jillian Virginia Schommer | Student in an Organized Health Care Education/Training Program | 801 Broadway N, Fargo, ND 58102-3641 | 2020-05-09 |
| 1194344036 | Sarah Rose Carpenter | Genetic Counselor, MS | 801 Broadway N, Fargo, ND 58102-3641 | 2020-04-10 |
| 1346871258 | Randall Hagemeister | Nurse Anesthetist, Certified Registered | 801 Broadway N, Fargo, ND 58102-3641 | 2020-01-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780285924 | Shelley Dene Townsend-hansen | Dentist | 1017 Broadway N, Fargo, ND 58102 | 2020-11-04 |
| 1275190779 | Anthony Joseph Duncan | Student in an Organized Health Care Education/Training Program | 1919 Elm Streent North, Fargo, ND 58102 | 2019-05-21 |
| 1003472317 | Sadie Marie Nelson | Nurse Practitioner | Sanford Broadway Clinic, 801 North Broadway, Fargo, ND 58102 | 2019-05-13 |
| 1124523576 | Christopher Peroutka | Specialist/Technologist | 1300 17th Ave N, Fargo, ND 58102 | 2018-03-28 |
| 1205331873 | Nathan Koens | Specialist/Technologist | 1300 17th Avenue North, Fargo, ND 58102 | 2018-03-27 |
| 1376063370 | Abby Nicole Fredrickson | Student in an Organized Health Care Education/Training Program | 1919 Elm Street North, Fargo, ND 58102 | 2017-06-21 |
| 1780118331 | Stephanie Melquist | Internal Medicine | Internal Medicine Resident Clinic, 801 N Broadway, Fargo, ND 58102 | 2017-04-19 |
| 1104215623 | Justin Lervik | Social Worker | 211 Elm St. N, 122, Fargo, ND 58102 | 2015-01-21 |
| 1770919441 | Courtney Ann Simanski | Speech-Language Pathologist | 415 4th St. N., Fargo, ND 58102 | 2013-09-25 |
| 1821431206 | Lanell Staroba | Pharmacist | 706 D 38th St, Fargo, ND 58102 | 2013-04-16 |
| Find all providers in zip 58102 | ||||
| Taxonomy Code | 2085N0700X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Neuroradiology |
| A radiologist who diagnoses and treats diseases utilizing imaging procedures as they relate to the brain, spine and spinal cord, head, neck and organs of special sense in adults and children. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528210879 | Seth Anderson | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2008-10-17 |
| 1780693424 | Jason M Asheim | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2006-08-05 |
| 1801814413 | Richard J Marsden | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
| 1033137682 | Stephen P Garrity | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
| 1588682165 | Steven L Mitchell | Radiology | 801 Broadway N, Fargo, ND 58102-3641 | 2006-07-18 |
| 1487681599 | Jerome M Sampson | Radiology | 3000 32nd Ave S, Fargo, ND 58103-6132 | 2006-06-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295081461 | Justin Mauch | Radiology | 1200 S Columbia Rd, Grand Forks, ND 58201 | 2012-07-25 |
| 1538229422 | Shawn A Schreiner | Radiology | 1200 S Columbia Rd, Grand Forks, ND 58201-4036 | 2006-12-11 |
| 1255420030 | Danko Victor Vidovich | Radiology | 1 Burdick Expy W, Minot, ND 58701-4406 | 2006-10-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.