Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 57085 | MN |
NPI | 1730390238 |
---|---|
Provider Name | Jeffrey Daniel Seybold |
First Address | Golden Valley, MN 55422-4841 |
Second Address | Edina, MN 55435-1706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 23/09/2013 |