Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 54720 | AZ |
N | 208600000X | Surgeon | 54720 | AZ |
Y | 2086S0129X | Vascular Surgeon | 68939 | MN |
NPI | 1114373941 |
---|---|
Provider Name | Matthew Dennis Breite |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2016 |
Last Update Date | 16/06/2021 |