Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 18044 | MN |
NPI | 1033168018 |
---|---|
Provider Name | Dr. Thomas Arthur Rivers |
First Address | Edina, MN 55435-2148 |
Second Address | Edina, MN 55435-2148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A96305 | (02) | MN |