Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0402X | Child Neurologist | 6989 | MT |
NPI | 1356414791 |
---|---|
Provider Name | Donald James Wight |
First Address | Clancy, MT 59634-9766 |
Second Address | Helena, MT 59601-4928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00093938 | (05) | MT |
B13133 | (02) | MT |