Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 41952 | WI |
NPI | 1013919968 |
---|---|
Provider Name | Richard E Belmont JR. |
First Address | Saint Cloud, MN 56303-2253 |
Second Address | Saint Cloud, MN 56303-2253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 09/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30096100 | (05) | WI |
G53533 | (02) |