Provider Demographics
NPI:1356585293
Name:DUFAN, TAREK A (MD)
Entity type:Individual
Prefix:
First Name:TAREK
Middle Name:A
Last Name:DUFAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4445
Mailing Address - Country:US
Mailing Address - Phone:701-222-6100
Mailing Address - Fax:701-222-6150
Practice Address - Street 1:500 N 8TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4445
Practice Address - Country:US
Practice Address - Phone:701-222-6100
Practice Address - Fax:701-222-6150
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND111472085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDP00779537OtherPALMETTO MEDICARE
ND14991Medicaid
ND1356585293OtherBLUECROSS BLUESHIELD
ND14991Medicaid