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General NPI Number Information
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NPI Number | 1790709830
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Entity Type | Organization
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Legal Business Name | ANOKA AREA FAMILY MEDICINE CLINIC, PA
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3883 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 | 763-421-2273
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Fax | 763-421-2236
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Provider Business Mailing Address
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Address Line | 14569 WACO ST NW
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City | RAMSEY
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State | MN
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Zip | 55303-6181
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Country | US
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Telephone | 763-421-7988
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Fax | 763-421-2236
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JOHN PETER LOES
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Credential | M.D.
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Telephone | 763-421-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 30144
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License Number State | MN
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