Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 56403 | MN |
Y | 2080P0207X | Pediatric Hematology-Oncologist | 56403 | MN |
NPI | 1093986176 |
---|---|
Provider Name | Ross William Perko |
First Address | Duluth, MN 55805-1951 |
Second Address | Duluth, MN 55805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2008 |
Last Update Date | 15/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093986176 | (05) | MI |
1093986176 | (05) | MN |
1093986176 | (05) | WI |