Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 5209 | MT |
NPI | 1104362888 |
---|---|
Provider Name | Charles Ludden |
First Address | Kalispell, MT 59901-7466 |
Second Address | Kalispell, MT 59901-7466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2017 |
Last Update Date | 18/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C64223 | (02) | MT |