Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 17773 | MN |
NPI | 1083625495 |
---|---|
Provider Name | Gaylan L Rockswold |
First Address | Minneapolis, MN 55415-1623 |
Second Address | Minneapolis, MN 55415-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2006 |
Last Update Date | 30/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A95368 | (02) |