Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 21128 | WI |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 69206 | MN |
NPI | 1083073167 |
---|---|
Provider Name | Jacob John Triplet |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2016 |
Last Update Date | 13/10/2021 |