Provider Demographics
NPI:1487616827
Name:ESPLUND, GRETCHEN MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:MARIE
Last Name:ESPLUND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:111 WASHINGTON AVENUE NORTH WEST
Mailing Address - Street 2:PO BOX 490
Mailing Address - City:WAGNER
Mailing Address - State:SD
Mailing Address - Zip Code:57380-0490
Mailing Address - Country:US
Mailing Address - Phone:605-384-3621
Mailing Address - Fax:605-384-5229
Practice Address - Street 1:111 WASHINGTON AVENUE NORTH WEST
Practice Address - Street 2:
Practice Address - City:WAGNER
Practice Address - State:SD
Practice Address - Zip Code:57380-0490
Practice Address - Country:US
Practice Address - Phone:605-384-3621
Practice Address - Fax:605-384-5229
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDH43587Medicare UPIN