Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301098362 | MI |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 62644 | MN |
NPI | 1225321102 |
---|---|
Provider Name | Trevor Charles Wahlquist |
First Address | Woodbury, MN 55125 |
Second Address | Woodbury, MN 55125-2522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2011 |
Last Update Date | 03/08/2017 |