Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 42865 | MN |
NPI | 1013930858 |
---|---|
Provider Name | Dr. Patrick Brian Ebeling |
First Address | Golden Valley, MN 55422-4840 |
Second Address | Burnsville, MN 55337 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 19/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H99597 | (02) | MN |