Healthcare Provider Details

I. General information

NPI: 1679802797
Provider Name (Legal Business Name): WILLIAM B ORR CONSULTING PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2009
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 MAIN ST STE 204
MENDOTA HTS MN
55118-1800
US

IV. Provider business mailing address

720 MAIN ST STE 204
MENDOTA HTS MN
55118-1800
US

V. Phone/Fax

Practice location:
  • Phone: 651-528-8183
  • Fax:
Mailing address:
  • Phone: 651-528-8183
  • Fax: 651-528-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number37439
License Number StateMN

VIII. Authorized Official

Name: WILLIAM ORR
Title or Position: OWNER
Credential: MD
Phone: 651-528-8183