Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 59106 | MN |
NPI | 1093020950 |
---|---|
Provider Name | Eduardo J. Colom Beauchamp |
First Address | Minneapolis, MN 55404-4515 |
Second Address | Saint Paul, MN 55101 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2010 |
Last Update Date | 09/11/2020 |