Provider Demographics
NPI:1871561886
Name:TRUEBLOOD, TED L (MD)
Entity type:Individual
Prefix:MR
First Name:TED
Middle Name:L
Last Name:TRUEBLOOD
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 1:523 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-3054
Mailing Address - Country:US
Mailing Address - Phone:218-829-2861
Mailing Address - Fax:
Practice Address - Street 1:221 MAIN ST N
Practice Address - Street 2:
Practice Address - City:PIERZ
Practice Address - State:MN
Practice Address - Zip Code:56364-1570
Practice Address - Country:US
Practice Address - Phone:320-468-2587
Practice Address - Fax:320-468-6219
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41752207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN080010202OtherMEDICARE WPS - HOSPITAL
MN080015849OtherMEDICARE WPS - GARRISON C
MN920719800Medicaid
MN080010210OtherMEDICARE WPS - MCGREGOR C
MN080010201OtherMEDICARE WPS - AITKIN CLI
MN080010201OtherMEDICARE WPS - AITKIN CLI