Provider Demographics
NPI:1487680930
Name:GJEVRE, JOHN ANKER SR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANKER
Last Name:GJEVRE
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1325 S RIVER DR
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-4055
Mailing Address - Country:US
Mailing Address - Phone:218-236-8566
Mailing Address - Fax:
Practice Address - Street 1:415 OAK ST
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1242
Practice Address - Country:US
Practice Address - Phone:218-643-3000
Practice Address - Fax:218-643-7502
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN18597207R00000X
MN3403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND28599Medicare UPIN