Healthcare Provider Details

I. General information

NPI: 1326029281
Provider Name (Legal Business Name): RAMON GENEROSO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 11/27/2023
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

320 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-7441
  • Fax: 406-257-0304
Mailing address:
  • Phone: 406-752-7441
  • Fax: 406-257-0304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number49428
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number037101
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: