Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 22404 | MN |
NPI | 1023052776 |
---|---|
Provider Name | Dr. John Kazuo Matsuura |
First Address | Sartell, MN 56377-2477 |
Second Address | Sartell, MN 56377-2477 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 02/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340000903 | RAILROAD MEDICARE (01) | MN |
936303300 | (05) | MN |
D48800 | (02) |