MEDICARE: JACOB MICHAEL TAVERNA 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	207R00000X	Internal Medicine Physician	7657	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	:	1811979099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB MICHAEL TAVERNA MD

Provider Business Mailing Address
First Line	:	435 S CRYSTAL ST
Second Line	:	SUITE 300
City	:	BUTTE
State	:	MT
Zip	:	59701-1506
Country	:	US
Telephone Number	:	406-496-3600
Fax Number	:	406-496-3653

Provider Business Practice Location Address
First Line	:	435 S CRYSTAL ST
Second Line	:	SUITE 300
City	:	BUTTE
State	:	MT
Zip	:	59701-1506
Country	:	US
Telephone Number	:	406-496-3600
Fax Number	:	406-496-3653

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	01/21/2008

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