Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 85265 | MT |
NPI | 1013362862 |
---|---|
Provider Name | Tysen Trujillo |
First Address | Billings, MT 59101-7520 |
Second Address | Billings, MT 59101-7520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2016 |
Last Update Date | 17/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013362862 | (05) | MT |