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Individual
JESSE COLE BOTKER
Active
Individual
JESSE COLE BOTKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
17798
MN
207X00000X
Orthopaedic Surgery Physician
Primary
52645
MN
207X00000X
Orthopaedic Surgery Physician
A107192
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09-03588
MEDICA
MN
01
—
138248000
US DOL
MN
01
—
1780887166
AMERICA'S PPO
MN
05
—
1780887166
—
MN
Enumeration date
06/06/2007
Last updated
07/22/2011
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