Doctor Name: | ROLAND GEORGE DUMONCEAUX |
NPI Number: | 1518172717 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 16505 |
Business Practice Address: | 6909 Gleason Road Edina, MN - 554391604 |
Business Phone Number: | 9529417188 |
Business Fax Number: | |
Mailing Address: | 6909 Gleason Road, EDINA |
State: | MN |
Postal Code: | 554391604 |
Phone Number: | 9529417188 |
Fax Number: | |
NPI Enumeration Date: | 05/11/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 16505 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |