Individual
MR. JESSE L GOEMBEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
550 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-5000
(763) 236-3516
Mailing address
550 OSBORNE RD NE, FRIDLEY, MN 55432-2718
(763) 236-5000
(763) 236-3516
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0643
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0643
STATE LICENSE
SD
01
—
1238
MN TEMPORARY LICENSE
MN
05
—
6829150
—
SD
Enumeration date
02/21/2007
Last updated
11/10/2020
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