Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 3750 | MN |
NPI | 1710014311 |
---|---|
Provider Name | Anthony Spurrill |
First Address | Eagan, MN 55122-2357 |
Second Address | Eagan, MN 55122-2357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 06/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U83251 | (02) | MN |