| NPI | 1902400690 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE QUALLS Practice Manager 406-294-9515 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery |
| Enumeration Date | 2020-11-24 |
| Last Update Date | 2020-11-24 |