Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 43888 | MT |
NPI | 1093845513 |
---|---|
Provider Name | Brian G Rose |
First Address | Bozeman, MT 59715-6904 |
Second Address | Bozeman, MT 59715-6904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2007 |
Last Update Date | 26/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093845513 | (05) | MT |
G82870 | (02) | WI |