Individual
EVAN L DOMEYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3960 COON RAPIDS BLVD NW, 100, COON RAPIDS, MN 55433-2569
(763) 236-9400
(763) 236-9423
Mailing address
PO BOX 43, MR 10809, MINNEAPOLIS, MN 55440-0043
(612) 262-4813
(612) 262-4194
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
44533
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
315794600
—
MN
Enumeration date
03/22/2006
Last updated
11/10/2020
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