Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 8969 | MN |
NPI | 1144205626 |
---|---|
Provider Name | Dr. Lawrence A Palmersheim |
First Address | Burnsville, MN 55337-6734 |
Second Address | Burnsville, MN 55337-6734 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 09/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
149318300 | (05) | MN |
6B230PA | BCBS (01) | MN |
86000125 | MEDICA (01) | |
T39839 | (02) |