Provider Demographics
NPI:1477662609
Name:VAURIO, C EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:EDWARD
Last Name:VAURIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S 8TH ST STE 600
Mailing Address - Street 2:PARKSIDE PROFESSIONAL BLDG
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1209
Mailing Address - Country:US
Mailing Address - Phone:612-339-7171
Mailing Address - Fax:612-339-2885
Practice Address - Street 1:825 S 8TH ST STE 600
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1209
Practice Address - Country:US
Practice Address - Phone:612-339-7171
Practice Address - Fax:612-339-2885
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN018720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNXX1920197002OtherBLUE CROSS BLUE SHIELD
MNB58537Medicare UPIN