Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 53367 | MN |
N | 204E00000X | Oral & Maxillofacial Surgeon | D12144 | MN |
NPI | 1174501092 |
---|---|
Provider Name | Matthew J Karban |
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 | 03/01/2006 |
Last Update Date | 22/11/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33826000 | (05) | WI |
598930200 | (05) | MN |
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |
V06980 | (02) |