Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 4928 | MT |
NPI | 1033203831 |
---|---|
Provider Name | Dr. Steven Lyle Rowley Shaneyfelt |
First Address | Bozeman, MT 59715 |
Second Address | Bozeman, MT 59715 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000005071 | BLUE CROSS BLUE SHIELD (01) | MT |
0980395 | (05) | MT |
C64172 | (02) |