Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 1164-25 | WI |
N | 222Z00000X | Podiatrist | 1164-25 | WI |
Y | 213E00000X | Podiatrist | 631 | MN |
Y | 222Z00000X | Podiatrist | 631 | MN |
NPI | 1043215528 |
---|---|
Provider Name | Mr. Bryan Mohr |
First Address | Richfield, MN 55423-2491 |
Second Address | Richfield, MN 55423-2673 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2005 |
Last Update Date | 29/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
124307 | UCARE (01) | MN |
148473700 | (05) | MN |
54B22MO | BLUE CROSS (01) | MN |
HP30542 | HEALTH PARTNERS (01) | MN |
U77236 | (02) | MN |