Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 891 | MT |
NPI | 1326201054 |
---|---|
Provider Name | Fred Wayne Pickering |
First Address | Red Lodge, MT 59068-0685 |
Second Address | Red Lodge, MT 59068-0685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 02/07/2008 |