Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3691 | MN |
NPI | 1114147667 |
---|---|
Provider Name | Dr. Ronald Denis Ledoux |
First Address | Golden Valley, MN 55422-3339 |
Second Address | Fridley, MN 55432-1846 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2007 |
Last Update Date | 28/10/2020 |