Provider Demographics
NPI:1548675770
Name:BEDIENT, MAYSON AMY (DO)
Entity type:Individual
Prefix:
First Name:MAYSON
Middle Name:AMY
Last Name:BEDIENT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:BEDEINT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1701 38TH ST S STE 101
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4499
Mailing Address - Country:US
Mailing Address - Phone:701-356-1500
Mailing Address - Fax:701-356-1596
Practice Address - Street 1:1701 38TH ST S STE 101
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4499
Practice Address - Country:US
Practice Address - Phone:701-356-1500
Practice Address - Fax:701-356-1596
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016071207Q00000X
MN72458207Q00000X
ND18954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine