Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080N0001X | Neonatal-Perinatal Doctor | 29954 | IA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | 49727 | MN |
NPI | 1144215088 |
---|---|
Provider Name | Thomas N George |
First Address | Minneapolis, MN 55404-4518 |
Second Address | Minneapolis, MN 55404-4518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 18/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0114819 | (05) | IA |
16955 | WELLMARK BCBS (01) | IA |
F85795 | (02) |