Healthcare Provider Details

I. General information

NPI: 1760466908
Provider Name (Legal Business Name): GREGORY PAUL RAPP PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 POLER ST
STARBUCK MN
56381-2456
US

IV. Provider business mailing address

501 POLER ST
STARBUCK MN
56381-2456
US

V. Phone/Fax

Practice location:
  • Phone: 320-239-3939
  • Fax: 320-239-2802
Mailing address:
  • Phone: 218-685-4461
  • Fax: 218-685-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9237
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: