Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D10552 | MN |
NPI | 1003861865 |
---|---|
Provider Name | Donald M. Primley |
First Address | Saint Cloud, MN 56303-3410 |
Second Address | Saint Cloud, MN 56303-3410 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U18806 | (02) | MN |