Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 48413 | MN |
N | 207PE0004X | Emergency Medical Services | 23596 | NE |
N | 207PE0004X | Emergency Medical Services | 36476 | IA |
NPI | 1194773671 |
---|---|
Provider Name | Paul John Vollmar JR. |
First Address | Cloquet, MN 55720-1199 |
Second Address | Cloquet, MN 55720-1199 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 19/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I49402 | (02) |