Healthcare Provider Details

I. General information

NPI: 1972580330
Provider Name (Legal Business Name): GEORGE E BELZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 PARK NICOLLET BLVD
ST LOUIS PARK MN
55416-2503
US

IV. Provider business mailing address

3800 PARK NICOLLET BLVD CREDENTIALING
ST LOUIS PARK MN
55416-2527
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-3180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number44299
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number44299
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: