Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | D13265 | MN |
NPI | 1366889479 |
---|---|
Provider Name | Eric J Wu |
First Address | Rochester, MN 55905-0001 |
Second Address | Columbia, MD 21045-2638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2013 |
Last Update Date | 05/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | MN |