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General NPI Number Information
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NPI Number | 1114387529
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Entity Type | Organization
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Legal Business Name | P J NOSS CORPORATION
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Dates
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Enumeration Date | 02/26/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1924 DUNEDIN AVE
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City | DULUTH
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State | MN
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Zip | 55803-2400
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Country | US
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Telephone | 218-312-3002
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Fax | 218-236-8933
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Provider Business Mailing Address
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Address Line | 1924 DUNEDIN AVE
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City | DULUTH
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State | MN
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Zip | 55803-2400
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Country | US
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Telephone | 218-310-8050
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHYLLIS J NOSS
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Credential | M.D.
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Telephone | 218-310-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State | MN
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