Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 8341 | MT |
NPI | 1053418582 |
---|---|
Provider Name | Dr. Gus Konstantine George Varnavas |
First Address | Anaconda, MT 59711-1931 |
Second Address | Anaconda, MT 59711-1931 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2006 |
Last Update Date | 06/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053418582 | (05) | MT |
1053418582 | NPI (01) | MT |
8341 | STATE LICENSE (01) | MT |