Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RR0500X | Rheumatology | 42668 | WI |
Y | 207RR0500X | Rheumatology | 48087 | MN |
NPI | 1114993961 |
---|---|
Provider Name | Sou-Pan Wu |
First Address | Saint Paul, MN 55130-5302 |
Second Address | St Paul, MN 55101-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 16/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
709448500 | (05) | MN |
I34548 | (02) |