Healthcare Provider Details

I. General information

NPI: 1841388089
Provider Name (Legal Business Name): GARREN C RUGGABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1191 S COLUMBIA RD
GRAND FORKS ND
58201-4033
US

IV. Provider business mailing address

166 4TH ST E
SAINT PAUL MN
55101-1421
US

V. Phone/Fax

Practice location:
  • Phone: 651-292-2009
  • Fax: 651-292-2178
Mailing address:
  • Phone: 651-292-2009
  • Fax: 651-292-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number6211
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: