Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD00042604 | WA |
N | 111NI0900X | Internist | MD00042604 | WA |
Y | 207RH0002X | Hospice and Palliative Medicine | 10956 | MT |
N | 207RH0002X | Hospice and Palliative Medicine | MD00042604 | WA |
NPI | 1023194800 |
---|---|
Provider Name | Kerry J Eby |
First Address | Kalispell, MT 59901-3129 |
Second Address | Kalispell, MT 59901-3129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 26/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2000703 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
8395675 | (05) | WA |
I09640 | (02) |