Individual
PHILIP DOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3548 BRYANT AVE S, MINNEAPOLIS, MN 55408-4119
(612) 767-8663
Mailing address
3548 BRYANT AVE S, MINNEAPOLIS, MN 55408-4119
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
390200000X
NPI TAXONOMY CODE
—
Enumeration date
09/24/2013
Last updated
09/24/2013
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