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General NPI Number Information
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NPI Number | 1982233599
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Entity Type | Individual
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Provider Name | GABRIEL JEROME AMON MD
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Gender | Male
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 18315 CASCADE DR STE 150
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City | EDEN PRAIRIE
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State | MN
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Zip | 55347-1185
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Country | US
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Telephone | 952-934-7336
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Fax |
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Provider Business Mailing Address
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Address Line | 119 14TH ST NW STE 240
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-0007
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Country | US
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Telephone | 763-571-4000
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 77244
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License Number State | MN
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