Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | M-8273 | ID |
Y | 207RI0011X | Interventional Cardiology | 9853 | MT |
NPI | 1003865171 |
---|---|
Provider Name | Mr. George Bandow |
First Address | Missoula, MT 59808-1752 |
Second Address | Missoula, MT 59808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 31/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
67388 | (05) | MT |
96485 | BLUE CROSS/BLUE SHIELD (01) | MT |
A002 | TRICARE (01) | MT |
B51348 | (02) | MT |
P00062024 | RAIL ROAD MEDICARE (01) | MT |