Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 807 | MT |
NPI | 1457424749 |
---|---|
Provider Name | Dr. Wade T Fike |
First Address | Billings, MT 59106-9508 |
Second Address | Billings, MT 59102-5319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 03/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000041181 | BLUE CROSS BLUE SHIELD (01) | MT |
U64335 | (02) | MT |