Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 35885 | MN |
NPI | 1033156823 |
---|---|
Provider Name | Benjamin Yokel |
First Address | Virginia, MN 55792-2329 |
Second Address | Virginia, MN 55792-2329 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 06/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
811508700 | (05) | MN |
F36103 | (02) |