Provider Demographics
NPI:1669812665
Name:THUEN, BOBBI RAE (MD)
Entity Type:Individual
Prefix:
First Name:BOBBI RAE
Middle Name:
Last Name:THUEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 NORTHERN SKY DR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-8538
Mailing Address - Country:US
Mailing Address - Phone:701-712-3000
Mailing Address - Fax:701-712-3005
Practice Address - Street 1:4535 NORTHERN SKY DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-8538
Practice Address - Country:US
Practice Address - Phone:701-712-3000
Practice Address - Fax:701-712-3005
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRL12810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12083Medicaid
ND12083Medicaid