Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 65638 | MN |
N | 111NI0900X | Internist | 65638 | MN |
Y | 207RH0002X | Hospice and Palliative Medicine | 65638 | MN |
NPI | 1073962395 |
---|---|
Provider Name | Matthew Eggebrecht |
First Address | Saint Cloud, MN 56303-1900 |
Second Address | Saint Cloud, MN 56303-1900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 22/09/2020 |