Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 9161 | ND |
Y | 207XS0106X | Orthopaedic Hand Surgeon | 63419 | MN |
N | 2086S0105X | Surgery of the Hand | 63419 | MN |
N | 2086S0105X | Surgery of the Hand | 9161 | ND |
NPI | 1407850225 |
---|---|
Provider Name | Dr. Jon David Norberg |
First Address | Maple Grove, MN 55311-2269 |
Second Address | Maple Grove, MN 55369-4463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 23/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12017 | (05) | ND |
278676100 | (05) | MN |
307M9NO | MN BLUE SHIELD (01) | MN |
63419 | PROFESSIONAL LICENSE (01) | MN |
H66982 | (02) | ND |
NOR24461 | ND BLUE SHIELD (01) | ND |
P00139507 | PALMETTO GBA-RR MEDICARE (01) | ND |