Individual
DR. GREGG N DYSTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11850 BLACKFOOT ST NW, SUITE 490, COON RAPIDS, MN 55433-2578
(763) 427-1137
Mailing address
11850 BLACKFOOT ST NW, SUITE 490, COON RAPIDS, MN 55433-2578
(763) 427-1137
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
32612
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
910895500
—
MN
Enumeration date
06/06/2006
Last updated
07/20/2015
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