Provider Demographics
NPI:1992901086
Name:MAANUM, SCOTT RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:RYAN
Last Name:MAANUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20600 FIREWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-6242
Mailing Address - Country:US
Mailing Address - Phone:218-292-9545
Mailing Address - Fax:218-255-8786
Practice Address - Street 1:20600 FIREWOOD TRL
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-6242
Practice Address - Country:US
Practice Address - Phone:218-292-9545
Practice Address - Fax:218-255-8786
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2024-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IA38086207Q00000X
MN52825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1992901086Medicaid
MN080019957Medicare PIN