Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 31371 | MN |
NPI | 1124137302 |
---|---|
Provider Name | Joseph Thomas Teynor |
First Address | St Louis Park, MN 55426-1728 |
Second Address | Edina, MN 55435-4534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/06/2009 |