Provider Demographics
NPI:1588626360
Name:BEDDOW, DAVID NOEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NOEL
Last Name:BEDDOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:550 OSBORNE RD NE
Practice Address - Street 2:
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432-2718
Practice Address - Country:US
Practice Address - Phone:763-236-5000
Practice Address - Fax:763-236-3524
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN36466208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN07F97BEOtherBCBS OF MN
MNHP19393OtherHEALTHPARTNERS
MN0413019OtherMEDICA
MN1011516OtherPREFERRED ONE
MN26691OtherAMERICA'S PPO
MN5356125OtherAETNA
MN861725200Medicaid
MN115835OtherUCARE MN