Individual
BRYAN THOMAS LAUFENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(651) 254-4887
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13768
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13768
MN PHYSICIAN ASSISTANT LICENSE
MN
Enumeration date
08/02/2021
Last updated
05/03/2024
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