Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 18665 | MN |
Y | 207RH0000X | Hematologist | 26690-20 | WI |
NPI | 1013947993 |
---|---|
Provider Name | Robert Dale Niedringhaus |
First Address | Duluth, MN 55805-1951 |
Second Address | Duluth, MN 55805-1951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 09/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
31287000 | (05) | WI |
521085200 | (05) | MN |
D48846 | (02) |