Individual
RONOVAN LAVAINE OTTENBACHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2101 ELM ST N, FARGO, ND 58102-2417
(701) 239-3700
Mailing address
2101 ELM ST N, FARGO, ND 58102-2417
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
13056
ND
Other
Enumeration date
08/02/2012
Last updated
03/03/2025
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