Provider Demographics
NPI:1881620805
Name:LOPERENA, RUDOLF (MD)
Entity type:Individual
Prefix:
First Name:RUDOLF
Middle Name:
Last Name:LOPERENA
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 1:905 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ND
Mailing Address - Zip Code:58054-4334
Mailing Address - Country:US
Mailing Address - Phone:701-683-6400
Mailing Address - Fax:701-683-4345
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ND
Practice Address - Zip Code:58054-4334
Practice Address - Country:US
Practice Address - Phone:701-683-6400
Practice Address - Fax:701-683-4345
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8003207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1455852Medicaid
ND0109976OtherMEDICA #
ND22412OtherNDBS #
ND65G32LOOtherMNBS #
NDND100046OtherLHS #
ND65G31LOOtherMNBS #
ND65G33LOOtherMNBS #
ND0109977OtherMEDICA #
ND1699729OtherAMERICA'S PPO/ARAZ #
ND10641Medicaid
NDDA9061031055OtherPREFERRED ONE #
NDHP38915OtherHEALTHPARTNERS #
NDHP38915OtherHEALTHPARTNERS #
ND65G33LOOtherMNBS #
ND22413Medicare PIN
ND0109977OtherMEDICA #