Basic Information
| Provider Information | |||||||||
| NPI: | 1609035120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RANUM | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 HIGHWAY 12 | ||||||||
| Address2: | |||||||||
| City: | HETTINGER | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586397530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015674561 | ||||||||
| FaxNumber: | 7015676301 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 HIGHWAY 12 | ||||||||
| Address2: | |||||||||
| City: | HETTINGER | ||||||||
| State: | ND | ||||||||
| PostalCode: | 586397530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015674561 | ||||||||
| FaxNumber: | 7015676301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2008 | ||||||||
| LastUpdateDate: | 05/14/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TRL 10914 | ND | N | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | 4301094829 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 11775 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.