Provider Demographics
NPI:1760466908
Name:RAPP, GREGORY PAUL (PA-C)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:PAUL
Last Name:RAPP
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:501 POLER ST
Mailing Address - Street 2:
Mailing Address - City:STARBUCK
Mailing Address - State:MN
Mailing Address - Zip Code:56381-2456
Mailing Address - Country:US
Mailing Address - Phone:218-685-4461
Mailing Address - Fax:218-685-6749
Practice Address - Street 1:501 POLER ST
Practice Address - Street 2:
Practice Address - City:STARBUCK
Practice Address - State:MN
Practice Address - Zip Code:56381-2456
Practice Address - Country:US
Practice Address - Phone:320-239-3939
Practice Address - Fax:320-239-2802
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9237363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN126630600Medicaid