Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 7526 | MN |
NPI | 1326023532 |
---|---|
Provider Name | Dr. Robert M Brandjord |
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 | 09/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
44B04BR | BCBS (01) | MN |
86000126 | MEDICA (01) | |
T39336 | (02) |