Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QS0010X | Family Doctor - Sports Medicine | 54825 | AZ |
Y | 207QS0010X | Family Doctor - Sports Medicine | 66357 | MN |
NPI | 1255793261 |
---|---|
Provider Name | Arie Degrio |
First Address | Grand Rapids, MN 55744-8648 |
Second Address | Grand Rapids, MN 55744-8648 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2016 |
Last Update Date | 03/09/2020 |