Healthcare Provider Details

I. General information

NPI: 1609965987
Provider Name (Legal Business Name): JESSIE J. SALISBURY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SO. CRYSTAL SUITE 300
BUTTE MT
59701-1506
US

IV. Provider business mailing address

435 SO. CRYSTAL SUITE 300
BUTTE MT
59701-1506
US

V. Phone/Fax

Practice location:
  • Phone: 406-496-3600
  • Fax: 406-496-3653
Mailing address:
  • Phone: 406-496-3600
  • Fax: 406-496-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7658
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: