Individual
JAIME DE LA FUENTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1185 TOWN CENTRE DR STE 205, EAGAN, MN 55123-1370
(612) 871-1145
(612) 870-5491
Mailing address
PO BOX 14909, MINNEAPOLIS, MN 55414-0909
(612) 871-1145
(612) 870-5491
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1447614086
MN
207RG0100X
Gastroenterology Physician
Primary
62505
MN
Other
Enumeration date
04/10/2016
Last updated
01/15/2024
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