Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 99336 | MT |
NPI | 1316473713 |
---|---|
Provider Name | Flint Ray |
First Address | Great Falls, MT 59405-5183 |
Second Address | Great Falls, MT 59405-5161 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2017 |
Last Update Date | 16/09/2021 |