Healthcare Provider Details

I. General information

NPI: 1053364752
Provider Name (Legal Business Name): DAVID G BUE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 NORTHLAND DR
PRINCETON MN
55371-2172
US

IV. Provider business mailing address

919 NORTHLAND DR
PRINCETON MN
55371-2172
US

V. Phone/Fax

Practice location:
  • Phone: 763-389-3344
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20919
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: