Individual
GARY J. MAYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1540 LAKE ST S, FOREST LAKE, MN 55025-2628
(651) 464-7100
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24813
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171098200
—
MN
Enumeration date
03/20/2006
Last updated
11/03/2011
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