Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 48468 | MN |
NPI | 1073531885 |
---|---|
Provider Name | John M Houle |
First Address | St Cloud, MN 56303 |
Second Address | St Cloud, MN 56303 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |