Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 6941 | MT |
NPI | 1033154760 |
---|---|
Provider Name | David W Shenton JR. |
First Address | Billings, MT 59101-7507 |
Second Address | Billings, MT 59101-7506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 02/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000002231 | BLUE CROSS (01) | MT |
0090727 | (05) | MT |
B56566 | (02) |