Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D10595 | MN |
NPI | 1083681928 |
---|---|
Provider Name | Dr. Nicholas H. Psimos |
First Address | Rochester, MN 55906-6841 |
Second Address | Rochester, MN 55906-6841 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 21/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0088575 | (05) | IA |
1B261PS | BCBS PROVIDER ID (01) | MN |
324222600 | (05) | MN |
T91003 | (02) | MN |