Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 48577 | MN |
Y | 207QS0010X | Family Doctor - Sports Medicine | 48577 | MN |
NPI | 1073772893 |
---|---|
Provider Name | Dr. Samuel A.l. Bugbee |
First Address | Bloomington, MN 55431-4800 |
Second Address | Bloomington, MN 55431-4800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2008 |
Last Update Date | 10/03/2015 |