Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 10894 | MT |
NPI | 1336218387 |
---|---|
Provider Name | Oscar Glenn Heyman |
First Address | Missoula, MT 59804-9403 |
Second Address | Missoula, MT 59802-4008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 19/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000009936 | GPIN (01) | |
I44578 | (02) |