Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 10947 | MT |
NPI | 1336250208 |
---|---|
Provider Name | Scott Richard Jahnke |
First Address | Kalispell, MT 59901-4240 |
Second Address | Kalispell, MT 59901-4240 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 26/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4976249-11 | (05) | MI |
554111654 | BLUE CROSS BLUE SHIELD (01) | MI |
F47688 | (02) |