Healthcare Provider Details

I. General information

NPI: 1205813201
Provider Name (Legal Business Name): M GENE PARRISH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14000 FAIRVIEW DR
BURNSVILLE MN
55337-5713
US

IV. Provider business mailing address

6465 WAYZATA BLVD SUITE 315
ST LOUIS PARK MN
55426-1728
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-8608
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35216
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: