Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 974 | MT |
NPI | 1407956915 |
---|---|
Provider Name | Dr. John E Francis JR. |
First Address | Kalispell, MT 59901-2813 |
Second Address | Kalispell, MT 59901-2813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40173 | BLUE CROSS BLUE SHIELD (01) | MT |
U83783 | (02) | MT |