Provider Demographics
NPI:1932143880
Name:SKIPPER, RONALD P (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:P
Last Name:SKIPPER
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 1:800S MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:RUGBY
Mailing Address - State:ND
Mailing Address - Zip Code:58368-2118
Mailing Address - Country:US
Mailing Address - Phone:701-776-5261
Mailing Address - Fax:701-776-5448
Practice Address - Street 1:310 WENDELL AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-538-6262
Practice Address - Fax:406-538-6298
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7733208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011001051OtherMEDICARE GROUP#
MTP00447979OtherRAILROAD MEDICARE
MT0000091398OtherBCBS MT
MT000083087OtherMEDICARE GROUP NO
MT0147577Medicaid
MT91856OtherBLUE CROSS PROV ID
MT0000091398OtherBCBS MT
MT91856OtherBLUE CROSS PROV ID
MT000084898Medicare ID - Type UnspecifiedMCARE PROVIDER NO