Healthcare Provider Details

I. General information

NPI: 1437419603
Provider Name (Legal Business Name): BRIAN JAMES RUGGLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2012
Last Update Date: 08/03/2020
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 GRAND AVE
DULUTH MN
55807-2737
US

IV. Provider business mailing address

400 E 3RD ST
DULUTH MN
55805
US

V. Phone/Fax

Practice location:
  • Phone: 218-786-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04-38413
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56703
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: