Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 27907 | MT |
N | 208600000X | Surgeon | 27907 | MT |
Y | 2086S0122X | Plastic and Reconstructive Surgery | 27907 | MT |
NPI | 1295997344 |
---|---|
Provider Name | Dr. Jarred Mcdaniel |
First Address | Bozeman, MT 59719-0095 |
Second Address | Bozeman, MT 59715-3551 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 17/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
M011008204 | (02) | MT |