Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 45328 | MN |
NPI | 1639121460 |
---|---|
Provider Name | Dr. James Edmund Call JR. |
First Address | Deerwood, MN 56444-6278 |
Second Address | Deerwood, MN 56444-6278 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 08/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E29175 | (02) | NE |