Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | MT 949CHI | MT |
NPI | 1033196027 |
---|---|
Provider Name | Dr. Stephen Y. Dobelbower |
First Address | Livingston, MT 59047-9022 |
Second Address | Livingston, MT 59047-9022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 15/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
40103 | BLUECROSS BLUESHIELD (01) | MT |
U77756 | (02) | MT |