Provider Demographics
NPI:1881953461
Name:SKOOGBERG, RONALD CARL (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:CARL
Last Name:SKOOGBERG
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 1:3025 HARBOR LANE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-5141
Mailing Address - Country:US
Mailing Address - Phone:763-746-3737
Mailing Address - Fax:866-602-2777
Practice Address - Street 1:3025 HARBOR LANE
Practice Address - Street 2:SUITE 101
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55447-5141
Practice Address - Country:US
Practice Address - Phone:763-746-3737
Practice Address - Fax:866-602-2777
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-16
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN28992207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine