Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A99345 | CA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 53014 | MN |
NPI | 1215133129 |
---|---|
Provider Name | Dr. Tenner Johan Guillaume |
First Address | Saint Paul, MN 55101-2507 |
Second Address | Saint Paul, MN 55101-2507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2007 |
Last Update Date | 01/12/2011 |