Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 8297 | MT |
NPI | 1255332102 |
---|---|
Provider Name | Glenn A Winslow |
First Address | Great Falls, MT 59405-5353 |
Second Address | Great Falls, MT 59405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 25/02/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0101252 | (05) | MT |
F86799 | (02) |