Healthcare Provider Details

I. General information

NPI: 1194769026
Provider Name (Legal Business Name): EDWARD JOHN ENGLISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14655 GALAXIE AVE
APPLE VALLEY MN
55124-8575
US

IV. Provider business mailing address

14655 GALAXIE AVE
APPLE VALLEY MN
55124-8575
US

V. Phone/Fax

Practice location:
  • Phone: 952-432-6161
  • Fax: 952-432-7019
Mailing address:
  • Phone: 952-432-6161
  • Fax: 952-432-7019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20669
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: