Basic Information
| Provider Information | |||||||||
| NPI: | 1932143880 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKIPPER | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800S MAIN AVE | ||||||||
| Address2: | |||||||||
| City: | RUGBY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583682118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017765261 | ||||||||
| FaxNumber: | 7017765448 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 WENDELL AVE | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | LEWISTOWN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594572267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065386262 | ||||||||
| FaxNumber: | 4065386298 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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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 | 208600000X | 7733 | ND | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 011001051 | 01 | MT | MEDICARE GROUP# | OTHER | P00447979 | 01 | MT | RAILROAD MEDICARE | OTHER | 0000091398 | 01 | MT | BCBS MT | OTHER | 000083087 | 01 | MT | MEDICARE GROUP NO | OTHER | 0147577 | 05 | MT | MEDICAID | 91856 | 01 | MT | BLUE CROSS PROV ID | OTHER |