Basic Information
Provider Information
NPI: 1669634184
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HEGGE
FirstName: RYAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 N 7TH ST
Address2:  
City: BISMARCK
State: ND
PostalCode: 585014439
CountryCode: US
TelephoneNumber: 7013236000
FaxNumber: 7013236000
Practice Location
Address1: 222 N 7TH ST
Address2:  
City: BISMARCK
State: ND
PostalCode: 585014436
CountryCode: US
TelephoneNumber: 7013235422
FaxNumber: 7013238645
Other Information
ProviderEnumerationDate: 06/26/2008
LastUpdateDate: 04/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 04/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X12729NDY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
2085R0202X125-054128ILN Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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