Individual
JAYME A BORK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
AMRTC 3301 7TH AVE N, ANOKA, MN 55303
(218) 340-4308
Mailing address
AMRTC 3301 7TH AVE N, ANOKA, MN 55303-4516
(218) 340-4308
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
41816
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
377716200
—
MN
Enumeration date
11/01/2006
Last updated
12/05/2019
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