Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 8070 | MT |
NPI | 1164423711 |
---|---|
Provider Name | Dr. John A Vallin |
First Address | Bozeman, MT 59715-8812 |
Second Address | Bozeman, MT 59715-8812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2005 |
Last Update Date | 15/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22491 | (05) | MT |
E82792 | (02) | MT |