Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2069 | MT |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 2069 | MT |
NPI | 1275630261 |
---|---|
Provider Name | Mr. Armando Anthony Gama |
First Address | Missoula, MT 59801-4226 |
Second Address | Missoula, MT 59801-4226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 26/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0112064 | (05) | MT |
GU87376 | (02) | MT |