Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 41848 | MN |
NPI | 1891729000 |
---|---|
Provider Name | Dr. Johannes Christiaan Coetzee |
First Address | Golden Valley, MN 55422-4840 |
Second Address | Edina, MN 55435-1706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 07/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G09660 | (02) | MN |