Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 102549 | MN |
NPI | 1003836800 |
---|---|
Provider Name | David J Nutz |
First Address | Bloomington, MN 55425-4516 |
Second Address | St Louis Park, MN 55416-2527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 09/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
073493000 | (05) | MN |
I 56229 | (02) | MN |