Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 9894 | MT |
NPI | 1396724159 |
---|---|
Provider Name | Dr. Christopher Ralph Price |
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 | 11/01/2006 |
Last Update Date | 18/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0040086 | (05) | MT |
H40424 | (02) | MT |