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General NPI Number Information
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NPI Number | 1992901086
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Entity Type | Individual
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Provider Name | SCOTT RYAN MAANUM M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 04/24/2024
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Provider Practice Location Address
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Address Line | 20600 FIREWOOD TRL
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City | PARK RAPIDS
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State | MN
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Zip | 56470-6242
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Country | US
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Telephone | 218-292-9545
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Fax | 218-255-8786
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Provider Business Mailing Address
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Address Line | 20600 FIREWOOD TRL
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City | PARK RAPIDS
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State | MN
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Zip | 56470-6242
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Country | US
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Telephone | 218-292-9545
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Fax | 218-255-8786
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38086
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 52825
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License Number State | MN
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