Basic Information
| Provider Information | |||||||||
| NPI: | 1306920111 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARRY | ||||||||
| FirstName: | GARETH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 DELAWARE ST SE | ||||||||
| Address2: | UNIVERSITY OF MINNESOTA PHYSICIANS | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550341 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126263004 | ||||||||
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| Practice Location | |||||||||
| Address1: | 516 DELAWARE ST SE | ||||||||
| Address2: | PWB FIRST FLOOR, CLINIC 1A | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554550356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6126263004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 35486 | MN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | 0021216 | 05 | MT | MEDICAID | 05-00009 | 01 | MN | MEDICA - PRIMARY | OTHER | 10387 | 05 | ND | MEDICAID | 1009264 | 01 | MN | PREFERREDONE | OTHER | 2T370PA | 01 | MN | BCBS | OTHER | 05-00246 | 01 | MN | MEDICA - CHOICE | OTHER | 0511014 | 05 | IA | MEDICAID | 31850000 | 05 | WI | MEDICAID | 100347 | 01 | MN | UCARE | OTHER | 604500 | 01 | MN | ARAZ | OTHER | 7777470 | 05 | SD | MEDICAID | HP21951 | 01 | MN | HEALTHPARTNERS | OTHER |