Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 51433 | MN |
Y | 2080P0203X | Pediatric Critical Care Doctor | 15547 | ND |
NPI | 1275757783 |
---|---|
Provider Name | Dr. Joey Lee Rexine |
First Address | Fargo, ND 58122-2484 |
Second Address | Fargo, ND 58104-7927 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2007 |
Last Update Date | 24/06/2019 |