Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 11354 | MT |
N | 1223D0004X | Dentist Anesthesiologist | 30877 | TX |
N | 1223G0001X | General Practice | 11354 | MT |
N | 213EG0000X | General Practice | 11354 | MT |
NPI | 1134504566 |
---|---|
Provider Name | Dr. Eric Andrew Nygard |
First Address | Frenchtown, MT 59834-9502 |
Second Address | Frenchtown, MT 59834-9502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2015 |
Last Update Date | 07/01/2019 |