Provider Demographics
NPI:1851379119
Name:BJORNSSON, RAGNVALDR BUCK (MD)
Entity type:Individual
Prefix:
First Name:RAGNVALDR
Middle Name:BUCK
Last Name:BJORNSSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:1200 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5868
Practice Address - Country:US
Practice Address - Phone:307-362-3711
Practice Address - Fax:307-352-8178
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6690A207P00000X
IDM8716207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID58024OtherBLUE CROSS OF ID
ID806470900Medicaid
WY605960009OtherFBL
WY314686OtherBSWY
ID1110121Medicare PIN
ID806470900Medicaid
H63916Medicare UPIN
WYP00395688Medicare PIN