Individual
MR. ROBERT TIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
14655 GALAXIE AVE, APPLE VALLEY, MN 55124-8602
(651) 241-3779
(651) 241-3825
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-9000
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12134
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1131661
NCCPA ID NUMBER
—
01
—
12134
MINNESOTA LICENSE TO PRACTICE NUMBER
MN
Enumeration date
07/19/2016
Last updated
07/19/2021
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