Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207SG0201X | Clinical Genetics (M.D.) | 105914 | MN |
N | 207SG0201X | Clinical Genetics (M.D.) | 52002 | AZ |
Y | 207SG0201X | Clinical Genetics (M.D.) | 54972 | MN |
N | 207SG0201X | Clinical Genetics (M.D.) | A117256 | CA |
N | 207SG0201X | Clinical Genetics (M.D.) | ME128562 | FL |
NPI | 1568697829 |
---|---|
Provider Name | Dr. Pavel N. Pichurin |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2009 |
Last Update Date | 19/08/2020 |