Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 68487 | MT |
N | 207PE0004X | Emergency Medical Services | 02000995 | IN |
NPI | 1184686859 |
---|---|
Provider Name | Bruce Speicher |
First Address | Polson, MT 59860-5315 |
Second Address | Polson, MT 59860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 31/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000181694 | ANTHEM (01) | IN |
100318640A | (05) | IN |
114340109 | (05) | MI |
930101007 | RAIL ROAD MEDICARE (01) | IN |
D94942 | (02) | IN |