Provider Demographics
NPI:1912004607
Name:SHIRRIFF, JOHN ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:SHIRRIFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2497 7TH AVENUE E
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORTH SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2496
Mailing Address - Country:US
Mailing Address - Phone:651-769-6437
Mailing Address - Fax:651-769-6426
Practice Address - Street 1:3460 WASHINGTON DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1338
Practice Address - Country:US
Practice Address - Phone:651-769-6200
Practice Address - Fax:651-769-6249
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2010-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN296512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN931278100Medicaid
MN931278100Medicaid
260001590Medicare PIN