Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 23964 | MN |
NPI | 1033131438 |
---|---|
Provider Name | Dr. Robin C Crandall |
First Address | St Louis Park, MN 55426-1728 |
Second Address | Fridley, MN 55432-1847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 10/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
73B80CR | BLUE CROSS BLUE SHIELD (01) | |
901547 | MEDICA (01) | |
969990266001 | PREFERREDONE (01) | |
A93878 | (02) | MN |
HP13099 | HEALTHPARTNERS (01) |