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NPI Code Detail

MEDICARE: RALPH RIED BOOM M.D.

MEDICARE: RALPH RIED BOOM M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician22897IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720086275
Entity Type Code : Individual
Provider Name (Legal Business Name) : RALPH RIED BOOM M.D.
Provider Business Mailing Address
First Line : P.O. BOX 359
Second Line : 709 W MAIN ST
City : MANCHESTER
State : IA
Zip : 52057-0359
Country : US
Telephone Number : 563-927-7985
Fax Number : 563-927-7934
Provider Business Practice Location Address
First Line : 709 W MAIN ST
Second Line :
City : MANCHESTER
State : IA
Zip : 52057-1526
Country : US
Telephone Number : 563-927-7985
Fax Number : 563-927-7934
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 10/28/2020

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