MEDICARE: ROBERT VINCENT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	10257	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043303167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT VINCENT MD

Provider Business Mailing Address
First Line	:	PO BOX 16900
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-6900
Country	:	US
Telephone Number	:	406-327-4640
Fax Number	:

Provider Business Practice Location Address
First Line	:	2618 SOUTH AVE W
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-6406
Country	:	US
Telephone Number	:	406-327-4640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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Directions to “ ROBERT VINCENT MD” Practice Location

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