Provider Demographics
NPI:1174579650
Name:REFSLAND, BRADLEY A (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:REFSLAND
Suffix:
Gender:M
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:218-732-2800
Mailing Address - Fax:218-732-2874
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:218-732-2874
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN022235207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0122662OtherMEDICA #
ND1240OtherNDBS #
FM261088400Medicaid
MN14349REOtherMNBS #
MN16494Medicaid
MNMN100025OtherLHS/BANNERHEALTH #
MN142056OtherUCARE #
MNHP19575OtherHEALTHPARTNERS #
MN0106055OtherMEDICA #
MN768714OtherAMERICA'S PPO/ARAZ #
MNDA9031015668OtherPREFERRED ONE #
MN6411OtherNDBS #
MN0122662OtherMEDICA #
MNHP19575OtherHEALTHPARTNERS #
MN080041584Medicare ID - Type UnspecifiedRR MEDICARE #
FM261088400Medicaid