Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 3746 | MN |
NPI | 1245272186 |
---|---|
Provider Name | Dr. William C Harralson |
First Address | Saint Louis Park, MN 55426-3671 |
Second Address | Saint Louis Park, MN 55426-3671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3746 | LICENSE (01) | MN |