Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 7907 | MT |
NPI | 1003801275 |
---|---|
Provider Name | Ms. Patricia A. Grantham |
First Address | Billings, MT 59107-5100 |
Second Address | Miles City, MT 59301-4769 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2005 |
Last Update Date | 03/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0080529 | (05) | MT |
F87776 | (02) | MT |