Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0131X | Foot Surgery | 338 | MN |
NPI | 1205856713 |
---|---|
Provider Name | Dr. Dale Herbert Vancil |
First Address | Saint Paul, MN 55110-5152 |
Second Address | Lino Lakes, MN 55110-5152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2006 |
Last Update Date | 08/07/2007 |