Provider Demographics
NPI:1841388089
Name:RUGGABER, GARREN C (MD)
Entity Type:Individual
Prefix:
First Name:GARREN
Middle Name:C
Last Name:RUGGABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1421
Mailing Address - Country:US
Mailing Address - Phone:651-292-2009
Mailing Address - Fax:651-292-2178
Practice Address - Street 1:1191 S COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4033
Practice Address - Country:US
Practice Address - Phone:651-292-2009
Practice Address - Fax:651-292-2178
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND62112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17377Medicare PIN
NDB56199Medicare UPIN