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General NPI Number Information
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NPI Number | 1275534612
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Entity Type | Organization
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Legal Business Name | NORTHERN OB GYN ASSOCIATES PC
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 3875 COON RAPIDS BLVD NW
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City | COON RAPIDS
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State | MN
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Zip | 55433-2518
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Country | US
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Telephone | 763-427-8500
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Fax | 763-427-8505
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Provider Business Mailing Address
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Address Line | SDS 12 2503 PO BOX 86
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-2503
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Country | US
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Telephone | 763-427-8500
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Fax | 763-427-8505
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN PHILIP WUST III
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Credential | M.D.
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Telephone | 763-427-8500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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