Provider Demographics
NPI:1053365122
Name:ERNSTER, DALE J (MD)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:J
Last Name:ERNSTER
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 1:401 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4247
Mailing Address - Country:US
Mailing Address - Phone:701-253-5300
Mailing Address - Fax:701-253-5402
Practice Address - Street 1:401 3RD ST SE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4247
Practice Address - Country:US
Practice Address - Phone:701-253-5300
Practice Address - Fax:701-253-5402
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4733207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0474OtherNDBS #
ND1015987OtherMEDICA #
ND00627EROtherMNBS #
ND7936OtherSIOUX VALLEY #
NDDA9061015618OtherPREFERRED ONE #
NDND100021OtherLHS/BANNER HEALTH #
ND40011EROtherMNBS #
ND900854OtherAMERICA'S PPO/ARAZ #
NDHP19509OtherHEALTHPARTNERS #
ND0105986OtherMEDICA #
ND0D301EROtherMN BS #
ND16051Medicaid
ND10749OtherNDBS #
ND142007OtherUCARE #
ND0067OtherNDBS #
ND14523Medicare ID - Type UnspecifiedND MEDICARE #
ND142007OtherUCARE #