MEDICARE: DR. JEFFREY MARIANO LAPORTE M.D.

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	207X00000X	Orthopaedic Surgery Physician	35055257	OH
2	207XS0106X	Orthopaedic Hand Surgery Physician	35055257	OH
3	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	35055257	OH
4	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	35055257	OH

General Provider Information

NPI Number	:	1548255540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY MARIANO LAPORTE M.D.

Provider Business Mailing Address
First Line	:	2360 MULLAN RD STE C
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1811
Country	:	US
Telephone Number	:	406-721-4436
Fax Number	:

Provider Business Practice Location Address
First Line	:	2360 MULLAN RD STE C
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59808-1811
Country	:	US
Telephone Number	:	406-721-4436
Fax Number	:	406-721-3907

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

Provider Enumeration Date	:	09/15/2005
Last Update Date	:	08/25/2014

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