Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 30772 | MN |
N | 111NI0900X | Internist | 30772 | MN |
Y | 2084N0400X | Neurologist | 69557 | MN |
NPI | 1003444043 |
---|---|
Provider Name | Ryan Patrick Coburn |
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 | 27/03/2020 |
Last Update Date | 13/07/2021 |