Provider Demographics
NPI:1457317349
Name:GAZZOLA, ROBERT K (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:GAZZOLA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:1230 E MAIN STREET MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1901 OLD MINNESOTA AVE
Practice Address - Street 2:MANKATO CLINIC AT DANIELS HEALTH CENTER
Practice Address - City:ST PETER
Practice Address - State:MN
Practice Address - Zip Code:56082
Practice Address - Country:US
Practice Address - Phone:507-934-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2020-07-10
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Provider Licenses
StateLicense IDTaxonomies
MN34593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN057862200Medicaid
MNNA2951023837OtherPREFERRED ONE
0937888OtherIOWA MA
605646OtherAMERICAS PPO
MNHP25592OtherHEALTH PARTNERS
MN0123583OtherMEDICA
MN115959OtherUCARE
MN0D977GAOtherBCBS
58088OtherSANFORD HEALTH PLAN
MNNA2951023837OtherPREFERRED ONE
MN0D977GAOtherBCBS