Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 3194 | MT |
NPI | 1114169836 |
---|---|
Provider Name | Robert Michael St. John |
First Address | Butte, MT 59701-0000 |
Second Address | Butte, MT 59701-0000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2009 |
Last Update Date | 26/03/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AS2040993 | DEA (01) | MT |