Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 45952 | MN |
NPI | 1013980119 |
---|---|
Provider Name | Joseph Gerard Cunniff |
First Address | Woodbury, MN 55125-4925 |
Second Address | Woodbury, MN 55125-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 15/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
884621900 | (05) | MN |
H92598 | (02) | |
P00959616 | RAILROAD MEDICARE PTAN (01) | UT |