Individual
AUTUMN BROGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
404 W FOUNTAIN ST, MAYO CLINIC HEALTH SYSTEM, DEPT OF EM, ALBERT LEA, MN 56007-2437
(507) 373-2384
Mailing address
404 W FOUNTAIN ST, MAYO CLINIC HEALTH SYSTEM, DEPT OF EM, ALBERT LEA, MN 56007-2437
(507) 373-2384
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
21206
MN
207P00000X
Emergency Medicine Physician
Primary
53558
MN
207P00000X
Emergency Medicine Physician
56455-20
WI
207P00000X
Emergency Medicine Physician
A117018
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21206
MN PERMIT NUMBER
MN
01
—
P01251460
RAILROAD MEDICARE
MN
Enumeration date
08/05/2008
Last updated
10/07/2020
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