Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2963 | MN |
NPI | 1487788063 |
---|---|
Provider Name | Dr. Joseph Hamilton Muldoon |
First Address | Slayton, MN 56172-1314 |
Second Address | Slayton, MN 56172-1314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 16/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U33904 | (02) | MN |