Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 31318 | MN |
NPI | 1568481109 |
---|---|
Provider Name | Ronald C Mcglennen |
First Address | Eden Prairie, MN 55344-3720 |
Second Address | Eden Prairie, MN 55344-3720 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 15/01/2013 |