Provider Demographics
NPI:1316911530
Name:GFRERER, JOHN W (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:GFRERER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:15245 BLUEBIRD ST NW
Mailing Address - Street 2:21110Q
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3554
Mailing Address - Country:US
Mailing Address - Phone:763-587-4600
Mailing Address - Fax:763-587-4615
Practice Address - Street 1:15245 BLUEBIRD ST NW
Practice Address - Street 2:MAIL STOP 39200A
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-3554
Practice Address - Country:US
Practice Address - Phone:763-712-6000
Practice Address - Fax:763-712-6090
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2014-05-30
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Provider Licenses
StateLicense IDTaxonomies
MN22852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN695587800Medicaid
A96239Medicare UPIN
MN695587800Medicaid