Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 113 | MT |
Y | 222Z00000X | Podiatrist | 113 | MT |
N | 213ES0131X | Foot Surgery | 113 | MT |
NPI | 1386642577 |
---|---|
Provider Name | John K Beighle |
First Address | Missoula, MT 59804-7420 |
Second Address | Missoula, MT 59804-7420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 08/09/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000007931 | BCBS (01) | MT |
0390422 | (05) | MT |
U50518 | (02) |