Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0120X | Pediatric Surgery | 2009019569 | MO |
Y | 2086S0120X | Pediatric Surgery | 54989 | MN |
NPI | 1649390378 |
---|---|
Provider Name | Dr. Bradley J Segura |
First Address | Minneapolis, MN 55414 |
Second Address | Minneapolis, MN 55454 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 01/11/2012 |