Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 42687 | MN |
Y | 207PP0204X | Pediatric Emergency Physician | 42687 | MN |
N | 208000000X | Pediatrician | 42687 | MN |
N | 2080P0204X | Pediatric Emergency Doctor | 42687 | MN |
NPI | 1205913324 |
---|---|
Provider Name | Jeffrey P Louie |
First Address | Roseville, MN 55113 |
Second Address | Minneapolis, MN 55454-1450 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 01/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
375497900 | (05) | MN |
G61110 | (02) |