Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 16827 | AZ |
N | 207N00000X | Dermatologist | 28319 | MN |
N | 207N00000X | Dermatologist | ME50090 | FL |
Y | 207ND0101X | MOHS-Micrographic Surgeon | 28319 | MN |
NPI | 1336126424 |
---|---|
Provider Name | Randall K Roenigk |
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 | 29/12/2005 |
Last Update Date | 05/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D81059 | (02) |