Healthcare Provider Details

I. General information

NPI: 1548369606
Provider Name (Legal Business Name): DAVID RITLAND TVERBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 FLORENCE AVE
OWATONNA MN
55060-4704
US

IV. Provider business mailing address

610 FLORENCE AVE
OWATONNA MN
55060-4704
US

V. Phone/Fax

Practice location:
  • Phone: 507-451-2630
  • Fax: 507-455-8133
Mailing address:
  • Phone: 507-455-7644
  • Fax: 507-455-7662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number33449
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: