Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 60818 | MN |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A171604 | CA |
NPI | 1326427444 |
---|---|
Provider Name | Devin Robert Mangold |
First Address | Rochester, MN 55905-0001 |
Second Address | Fresno, CA 93720-3391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2015 |
Last Update Date | 24/09/2021 |