Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 35094101 | OH |
Y | 207PE0004X | Emergency Medical Services | 12787 | ND |
NPI | 1124214366 |
---|---|
Provider Name | Ryan Agema |
First Address | Fargo, ND 58107-2168 |
Second Address | Fargo, ND 58102-3641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2007 |
Last Update Date | 14/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
18185 | (05) | ND |