Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 69942 | MN |
NPI | 1164950804 |
---|---|
Provider Name | Donald Joyce |
First Address | Coon Rapids, MN 55433-2578 |
Second Address | Coon Rapids, MN 55433-2578 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2017 |
Last Update Date | 07/09/2021 |