Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | 60619 | MT |
NPI | 1336171149 |
---|---|
Provider Name | Deborah L Rose |
First Address | Great Falls, MT 59401-2510 |
Second Address | Great Falls, MT 59401-2510 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 03/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F85664 | (02) | AK |