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General NPI Number Information
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NPI Number | 1730106576
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Entity Type | Individual
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Provider Name | RAYMOND JOHN POOR M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 2085 RICE ST
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City | ROSEVILLE
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State | MN
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Zip | 55113-6807
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Country | US
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Telephone | 651-489-9035
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Fax | 651-489-6373
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Provider Business Mailing Address
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Address Line | 6200 SHINGLE CREEK PKWY SUITE 260
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City | BROOKLYN CENTER
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State | MN
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Zip | 55430-2128
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Country | US
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Telephone | 763-561-5349
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 45375
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License Number State | MN
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