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General NPI Number Information
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NPI Number | 1285671263
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Entity Type | Organization
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Legal Business Name | ADVANCED ORTHOPAEDIC SURGERY, P.A.
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1805 HENNEPIN AVE N
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City | GLENCOE
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State | MN
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Zip | 55336-1416
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Country | US
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Telephone | 320-864-3121
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Fax |
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Provider Business Mailing Address
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Address Line | 6633 BRENDEN CT
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City | CHANHASSEN
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State | MN
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Zip | 55317-7560
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Country | US
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Telephone | 952-470-2231
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARK CONRAD GREGERSON
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Credential | MD
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Telephone | 952-470-2231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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