Healthcare Provider Details

I. General information

NPI: 1194700690
Provider Name (Legal Business Name): MARSHA GAUNT ALEXANDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE DEPT OF OB/GYN; P5
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

701 PARK AVE PHYSICIAN SERVICES; S6
MINNEAPOLIS MN
55415-1623
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-2750
  • Fax: 612-904-4274
Mailing address:
  • Phone: 612-347-5320
  • Fax: 612-373-1886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25271
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: