Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 24753 | MN |
NPI | 1003883927 |
---|---|
Provider Name | Bryce C. Beverlin |
First Address | Minneapolis, MN 55404-4522 |
Second Address | Minneapolis, MN 55407-3723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A93798 | (02) |