Provider Demographics
NPI:1306920111
Name:PARRY, GARETH J (MD)
Entity type:Individual
Prefix:
First Name:GARETH
Middle Name:J
Last Name:PARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 DELAWARE ST SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0341
Mailing Address - Country:US
Mailing Address - Phone:612-626-3004
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB FIRST FLOOR, CLINIC 1A
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-626-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN354862084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0021216Medicaid
MN05-00009OtherMEDICA - PRIMARY
ND10387Medicaid
MN1009264OtherPREFERREDONE
MN2T370PAOtherBCBS
MN05-00246OtherMEDICA - CHOICE
IA0511014Medicaid
WI31850000Medicaid
MN100347OtherUCARE
MN604500OtherARAZ
SD7777470Medicaid
MNHP21951OtherHEALTHPARTNERS
WI31850000Medicaid