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General NPI Number Information
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NPI Number | 1790879575
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Entity Type | Individual
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Provider Name | RAMON R. DE GUZMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 166 19TH STREET SOUTH SUITE 100
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City | SARTELL
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State | MN
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Zip | 56377-2154
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Country | US
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Telephone | 320-251-0609
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Fax | 320-251-3806
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Provider Business Mailing Address
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Address Line | PO BOX 1450 NW 6035
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City | MINNEAPOLIS
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State | MN
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Zip | 55485-6035
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Country | US
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Telephone | 952-542-8553
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Fax | 952-513-6880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | 35.088582
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 51689
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License Number State | MN
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