Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 59670 | MN |
NPI | 1003136839 |
---|---|
Provider Name | Eric John Chapman |
First Address | Brainerd, MN 56401-3054 |
Second Address | Brainerd, MN 56401-4529 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2010 |
Last Update Date | 08/01/2016 |