Healthcare Provider Details

I. General information

NPI: 1447606561
Provider Name (Legal Business Name): BRYAN MATTHEW JEPSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2016
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 JACKSON ST
SAINT PAUL MN
55101-2502
US

IV. Provider business mailing address

CHILDREN'S HEALTH CARE 2525 CHICAGO AVENUE SOUTH
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: 651-254-4887
  • Fax:
Mailing address:
  • Phone: 612-813-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number75014
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number75014
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: