Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 29879 | MN |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 29879 | MN |
NPI | 1003884198 |
---|---|
Provider Name | Lee W Rock |
First Address | Minneapolis, MN 55425-4516 |
Second Address | Minneapolis, MN 55407-3570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 28/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A02484 | (02) |