Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 16585 | MN |
NPI | 1528163581 |
---|---|
Provider Name | Dr. James Herbert House |
First Address | Roseville, MN 55113-3829 |
Second Address | Minneapolis, MN 55417-2309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 12/07/2007 |