Healthcare Provider Details

I. General information

NPI: 1083882187
Provider Name (Legal Business Name): MONTANA ALLERGY AND ASTHMA SPEC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N #302E
BILLINGS MT
59101
US

IV. Provider business mailing address

2900 12TH AVE N #302E
BILLINGS MT
59101
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5500
  • Fax: 406-237-5510
Mailing address:
  • Phone: 406-237-5500
  • Fax: 406-237-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number10269
License Number StateMT

VIII. Authorized Official

Name: STEPHEN BERNARD FRITZ
Title or Position: PRESIDENT
Credential: MD
Phone: 406-237-5500