Healthcare Provider Details

I. General information

NPI: 1790002244
Provider Name (Legal Business Name): MATHEW WESTMARK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SOUTH 27TH STREET RIVERSTONE HEATLH
BILLINGS MT
59101
US

IV. Provider business mailing address

123 SOUTH 27TH STREET RIVERSTONE HEATLH
BILLINGS MT
59101
US

V. Phone/Fax

Practice location:
  • Phone: 406-247-3306
  • Fax:
Mailing address:
  • Phone: 406-247-3306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28887
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: