Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1758 | MN |
NPI | 1174560973 |
---|---|
Provider Name | Dr. Richard L. Mayfield |
First Address | Edina, MN 55435-5281 |
Second Address | Edina, MN 55435-5281 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/10/2013 |