Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 30908 | MN |
NPI | 1023087376 |
---|---|
Provider Name | Peter Daly |
First Address | Woodbury, MN 55125-4925 |
Second Address | Saint Paul, MN 55102-1223 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2006 |
Last Update Date | 01/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200012413 | RAILROAD MEDICARE (01) | MN |
485500100 | (05) | MN |
E98402 | (02) | MN |