Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 4749 | MN |
NPI | 1316901853 |
---|---|
Provider Name | Dr. Eric Brian Lund |
First Address | Maplewood, MN 55109-2641 |
Second Address | Maplewood, MN 55109-2641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
594K7AD | 594K7AD (01) | MN |