Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 6808635-1205 | UT |
N | 111NI0900X | Internist | 6808635-1205 | UT |
Y | 207RX0202X | Medical Oncology | 12523 | MT |
NPI | 1104002195 |
---|---|
Provider Name | Dr. Justin Daniel Thomas |
First Address | Bozeman, MT 59715-6911 |
Second Address | Bozeman, MT 59715-6914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2008 |
Last Update Date | 27/07/2021 |