Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 52429 | MN |
N | 207PP0204X | Pediatric Emergency Physician | 52429 | MN |
NPI | 1265680144 |
---|---|
Provider Name | Dr. Jeffrey Richard Dahlen |
First Address | Fort Snelling, MN 55111-2201 |
Second Address | Minneapolis, MN 55404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 05/06/2018 |