Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 46572 | CO |
NPI | 1164569448 |
---|---|
Provider Name | Jerimiah Lysinger |
First Address | Billings, MT 59107-5100 |
Second Address | Billings, MT 59101-0703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 10/01/2013 |