Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 36412 | MN |
Y | 207RH0003X | Hematology & Oncology | 36412 | MN |
N | 207RX0202X | Medical Oncology | 36412 | MN |
NPI | 1316970536 |
---|---|
Provider Name | Jonathan Robert Sande |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Bemidji, MN 56601-5112 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
085525100 | (05) | MN |
32448000 | (05) | WI |
F59930 | (02) |