Healthcare Provider Details

I. General information

NPI: 1750308755
Provider Name (Legal Business Name): RONALD M BURD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CONEY ST W
PERHAM MN
56573-2102
US

IV. Provider business mailing address

PO BOX 2010
FARGO ND
58122-0605
US

V. Phone/Fax

Practice location:
  • Phone: 218-347-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number27819
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5330
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: