Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 4159 | MT |
NPI | 1033131891 |
---|---|
Provider Name | George W Mclean |
First Address | Kalispell, MT 59901 |
Second Address | Kalispell, MT 59901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0047801 | (05) | MT |
D20526 | (02) |