Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 25MB05029700 | NJ |
NPI | 1013999598 |
---|---|
Provider Name | Dr. Jonathan B Pine |
First Address | Anaconda, MT 59711-1931 |
Second Address | Anaconda, MT 59711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 31/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013999598 | (05) | MT |
E69532 | (02) |