Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 10383 | MT |
NPI | 1073549093 |
---|---|
Provider Name | Ralph M Costanzo |
First Address | Billings, MT 59101-7504 |
Second Address | Billings, MT 59101-7506 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 21/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0065559 | (05) | MT |
F83585 | (02) |