Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 772 | MN |
NPI | 1023087814 |
---|---|
Provider Name | John B Buren |
First Address | Wyoming, MN 55092-8013 |
Second Address | Wyoming, MN 55092-8013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 17/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0199631 | STATE WRKS COMP (01) | WA |
7680BU | REGENCE BLUE SHIELD (01) | WA |
772 | STATE LICENSE (01) | MN |
8428757 | (05) | WA |
V06381 | (02) | WA |