Healthcare Provider Details

I. General information

NPI: 1164416814
Provider Name (Legal Business Name): JIMMIE LEE ASHCRAFT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 S 27TH ST
BILLINGS MT
59101-4200
US

IV. Provider business mailing address

RR 2 BOX 2162
SIDNEY MT
59270-9802
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-3350
  • Fax:
Mailing address:
  • Phone: 406-482-4272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3940
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: