Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 8708 | MT |
Y | 207VE0102X | Reproductive Endocrinologist | 8708 | MT |
NPI | 1497838379 |
---|---|
Provider Name | Stacy H. Shomento |
First Address | Billings, MT 59107-5100 |
Second Address | Bozeman, MT 59715-6900 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 22/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000099435 | BCBS PIN (01) | MT |
0095336 | MDCD PIN (01) | MT |
H03735 | (02) | MT |