Healthcare Provider Details

I. General information

NPI: 1255461745
Provider Name (Legal Business Name): JOHN PATRICK BOLLINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 03/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 1ST ST STE. 302
DULUTH MN
55805-2201
US

IV. Provider business mailing address

920 E 1ST ST STE. 302
DULUTH MN
55805-2201
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-6050
  • Fax: 218-249-6055
Mailing address:
  • Phone: 218-249-6050
  • Fax: 218-249-6055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number49932
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number49932
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: