Basic Information
| Provider Information | |||||||||
| NPI: | 1093769291 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBRITSCH | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 N 9TH ST | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585014507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017124560 | ||||||||
| FaxNumber: | 7017124191 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 E ROSSER AVE | ||||||||
| Address2: | |||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585014414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017124500 | ||||||||
| FaxNumber: | 7017124098 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5899 | ND | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 160018356 | 01 | ND | MEDICARE RAILROAD | OTHER | 16790 | 05 | ND | MEDICAID |