Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 26706 | MN |
NPI | 1063476323 |
---|---|
Provider Name | Thomas H Ayre |
First Address | Edina, MN 55435-2148 |
Second Address | Edina, MN 55435-2148 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 04/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
081562400 | (05) | MN |
A93921 | (02) |