Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 30056 | MN |
Y | 207V00000X | Obstetrician & Gynecologist | 68011 | MN |
NPI | 1013477157 |
---|---|
Provider Name | Brandon Paul Maddy |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2019 |
Last Update Date | 26/08/2020 |