Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 10696 | MT |
NPI | 1053423798 |
---|---|
Provider Name | Dr. Michael Sanford Lifson |
First Address | Dillon, MT 59725 |
Second Address | Dillon, MT 59725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 29/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E45604 | (02) | MD |