Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 13933 | PR |
Y | 207X00000X | Orthopaedic Surgeon | 69031 | MN |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 69031 | MN |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 69031 | MN |
N | 208200000X | Surgeon | 13933 | PR |
N | 208600000X | Surgeon | 13933 | PR |
NPI | 1134515091 |
---|---|
Provider Name | Edwin Gabriel Rosado Hernandez |
First Address | Bloomington, MN 55425-4516 |
Second Address | Saint Paul, MN 55101-2502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2015 |
Last Update Date | 07/02/2022 |