Healthcare Provider Details

I. General information

NPI: 1659878833
Provider Name (Legal Business Name): JOSHUA EARL LIDER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 WINNE AVE
HELENA MT
59601-4921
US

IV. Provider business mailing address

2442 WINNE AVE
HELENA MT
59601-4921
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-4100
  • Fax:
Mailing address:
  • Phone: 406-457-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number11420218-1204
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A19883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: