Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 31060 | MN |
NPI | 1033196969 |
---|---|
Provider Name | John M Worley |
First Address | St Louis Park, MN 55426-4705 |
Second Address | St Louis Park, MN 55426-4705 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2005 |
Last Update Date | 08/03/2012 |