Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 38554 | MT |
NPI | 1003897646 |
---|---|
Provider Name | David Joly |
First Address | North Augusta, SC 29841-3862 |
Second Address | Bozeman, MT 59715-6911 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 22/10/2015 |