Healthcare Provider Details

I. General information

NPI: 1548880958
Provider Name (Legal Business Name): JACOB JOHN MUSHABEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N STE 140W
BILLINGS MT
59101-7507
US

IV. Provider business mailing address

2900 12TH AVE N STE 140W
BILLINGS MT
59101-7507
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-6325
  • Fax:
Mailing address:
  • Phone: 406-238-6325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number173574
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: