Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 100085 | CA |
Y | 207W00000X | Ophthalmologist | 11765 | MT |
NPI | 1023229762 |
---|---|
Provider Name | Dr. Chad Michael Nedrud |
First Address | Missoula, MT 59806-4907 |
Second Address | Missoula, MT 59801-6772 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 13/12/2021 |