Individual
JONATHAN J. SUDBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6500 EXCELSIOR BLVD, METHODIST HOSPITAL, 2ND FLOOR RADIOLOGY, ST LOUIS PARK, MN 55426-4702
(952) 993-0349
Mailing address
6500 EXCELSIOR BLVD, METHODIST HOSPITAL, 2ND FLOOR RADIOLOGY, ST LOUIS PARK, MN 55426-4702
(952) 993-0349
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
48060
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
852658300
—
MN
Enumeration date
01/13/2006
Last updated
07/08/2007
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