Individual
DANIEL M GOLDBLATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
640 JACKSON ST, SAINT PAUL, MN 55101-2502
(123) 123-1234
(651) 254-3662
Mailing address
8100 34TH AVE S, MC21110Q, BLOOMINGTON, MN 55425-1672
(123) 123-1234
(651) 254-3662
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
29069
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
562075900
—
MN
Enumeration date
02/01/2006
Last updated
08/14/2008
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