Healthcare Provider Details

I. General information

NPI: 1194915744
Provider Name (Legal Business Name): GLENN MCLAUGHLIN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S ALABAMA ST SUITE 1
BUTTE MT
59701-2315
US

IV. Provider business mailing address

401 S ALABAMA ST SUITE 1
BUTTE MT
59701-2315
US

V. Phone/Fax

Practice location:
  • Phone: 406-465-0787
  • Fax: 406-723-8063
Mailing address:
  • Phone: 406-465-0787
  • Fax: 406-723-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number6220
License Number StateMT

VIII. Authorized Official

Name: GLENN MCLAUGHLIN
Title or Position: PRESIDENT
Credential: MD
Phone: 406-465-0787