Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 1778 | MN |
NPI | 1467442509 |
---|---|
Provider Name | Dr. Gordon Arthur Staff |
First Address | St. Louis Park, MN 55416-2734 |
Second Address | St Louis Park, MN 55416-2730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T66167 | (02) | MN |