Provider Demographics
NPI:1962806448
Name:RAM, JAIA RAYNE (MD)
Entity type:Individual
Prefix:
First Name:JAIA
Middle Name:RAYNE
Last Name:RAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 44TH AVE S
Mailing Address - Street 2:APT 109
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-3992
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4901 44TH AVE S
Practice Address - Street 2:APT 109
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-3992
Practice Address - Country:US
Practice Address - Phone:701-277-6939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA435690207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology