Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 65642 | MT |
NPI | 1043655046 |
---|---|
Provider Name | Morris Lynn Jessop |
First Address | Great Falls, MT 59405-5183 |
Second Address | Great Falls, MT 59405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2013 |
Last Update Date | 02/04/2021 |