Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 35741 | MT |
NPI | 1063604338 |
---|---|
Provider Name | Dr. Rebecca Coenen Belsom |
First Address | Missoula, MT 59807-7609 |
Second Address | Missoula, MT 59802-4008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2007 |
Last Update Date | 21/06/2021 |