Healthcare Provider Details

I. General information

NPI: 1174311344
Provider Name (Legal Business Name): RORY GWIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 RICE ST # NA
SAINT PAUL MN
55117-4949
US

IV. Provider business mailing address

9400 HILLSIDE DR
CHAMPLIN MN
55316-2616
US

V. Phone/Fax

Practice location:
  • Phone: 651-326-9020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39783
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: