Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 606 | MN |
NPI | 1003966052 |
---|---|
Provider Name | Dr. Timothy J Felton |
First Address | Golden Valley, MN 55422-3955 |
Second Address | Golden Valley, MN 55422-3946 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
163936600 | (05) | MN |
U72782 | (02) | MN |