Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 8432 | MT |
NPI | 1023063070 |
---|---|
Provider Name | John David Anthony Lakatua |
First Address | Missoula, MT 59807-7609 |
Second Address | Missoula, MT 59802-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0107763 | (05) | MT |
G87010 | (02) |