Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | C041516 | CA |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 103500 | MN |
NPI | 1134280324 |
---|---|
Provider Name | Kent Michael Patrick |
First Address | Fairmont, MN 56031-4469 |
Second Address | Fairmont, MN 56031-4469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 30/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C415160 | (05) | CA |
154N4PA | BLUE CROSS BLUE SHIELD (01) | MN |
A37619 | (02) |