Healthcare Provider Details

I. General information

NPI: 1558337154
Provider Name (Legal Business Name): ROBERT L GAUTHIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/14/2022
Certification Date: 07/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7261 OHMS LN
EDINA MN
55439-2148
US

IV. Provider business mailing address

7261 OHMS LN
EDINA MN
55439-2148
US

V. Phone/Fax

Practice location:
  • Phone: 952-843-4333
  • Fax: 952-843-4301
Mailing address:
  • Phone: 952-843-4333
  • Fax: 952-843-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number27854
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number27854
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: