Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 43562 | MN |
Y | 208600000X | Surgeon | 43562 | MN |
NPI | 1023076064 |
---|---|
Provider Name | Dr. Benjamin Patrick Roy |
First Address | Bemidji, MN 56601-5112 |
Second Address | Bemidji, MN 56601-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 03/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H36634 | (02) | MN |