Individual
PAUL M DITMANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
HWY 1 BOX 497, PHS INDIAN HOSPITAL, RED LAKE, MN 56671
(218) 679-3912
(218) 679-0181
Mailing address
HWY 1 BOX 497, PHS INDIAN HOSPITAL, RED LAKE, MN 56671
(218) 679-3912
(218) 679-0181
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30915
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30915
MINNESOTA LICENSE
MN
05
—
476753500
—
MN
Enumeration date
10/23/2006
Last updated
11/08/2007
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