Individual
JONATHAN GOMBOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6401 FRANCE AVE S, EDINA, MN 55435
(763) 559-3779
(763) 450-3986
Mailing address
14700 28TH AVE N STE 20, PLYMOUTH, MN 55447-4876
(763) 559-3779
(763) 450-3986
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
50832
MN
207L00000X
Anesthesiology Physician
55760-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
61154
DEAN HEALTH INSURANCE
WI
Enumeration date
06/13/2007
Last updated
05/31/2018
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