Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 15371 | NV |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A130888 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD158161 | OR |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MED-PHYS-LIC-36762 | MT |
NPI | 1720222508 |
---|---|
Provider Name | Dr. Brent Muir Roster |
First Address | Missoula, MT 59808-1811 |
Second Address | Missoula, MT 59808-1811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2009 |
Last Update Date | 06/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1720222508 | (05) | NV |