Healthcare Provider Details

I. General information

NPI: 1144261074
Provider Name (Legal Business Name): RANAE DOLL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 PLEASANT AVE S
PARK RAPIDS MN
56470-1440
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 218-732-2800
  • Fax: 218-732-2874
Mailing address:
  • Phone: 701-364-8000
  • Fax: 701-364-8078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52195
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52195
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: