Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 60900 | MN |
NPI | 1003295726 |
---|---|
Provider Name | Dr. David Shrake |
First Address | Woodbury, MN 55125-2337 |
Second Address | Woodbury, MN 55125-2337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2015 |
Last Update Date | 10/11/2020 |