Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN20400 | FL |
NPI | 1023307113 |
---|---|
Provider Name | Jonathan Colin Mccabe |
First Address | Mankato, MN 56001-5600 |
Second Address | Mankato, MN 56001-5600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 14/06/2017 |