MEDICARE: RONALD W BRUMMER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	26204	MN

General Provider Information

NPI Number	:	1396842175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD W BRUMMER MD

Provider Business Mailing Address
First Line	:	PO BOX 6002
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58206-6002
Country	:	US
Telephone Number	:	701-780-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	4440 S WASHINGTON ST
Second Line	:
City	:	GRAND FORKS
State	:	ND
Zip	:	58201-7245
Country	:	US
Telephone Number	:	701-732-7000
Fax Number	:	701-732-7696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	11/18/2020

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