Provider Demographics
NPI:1982613246
Name:HOVERSON SCHOTT, ALYSSA R (MD)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:R
Last Name:HOVERSON SCHOTT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:R
Other - Last Name:HOVERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:625 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1833
Practice Address - Country:US
Practice Address - Phone:218-773-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48913207N00000X
AZ40404207N00000X
ND11319207N00000X
MNMN-48913207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ350219Medicaid
MNP00610304OtherRAILROAD MEDICARE
MN228673100Medicaid
AZP00624826OtherRAILROAD MEDICARE
AZP00624826OtherRAILROAD MEDICARE
MNI61028Medicare UPIN
MN228673100Medicaid