Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 11047 | MT |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 11047 | MT |
NPI | 1356386437 |
---|---|
Provider Name | Dr. Leah J Carlburg |
First Address | Kalispell, MT 59901-3129 |
Second Address | Kalispell, MT 59901-3129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1356386437 | (05) | MT |
1356386437 | BCBS (01) | MT |