Healthcare Provider Details

I. General information

NPI: 1164107959
Provider Name (Legal Business Name): RYAN JAMESON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3171 US HIGHWAY 93 N STE B
KALISPELL MT
59901-1360
US

IV. Provider business mailing address

3171 US HIGHWAY 93 N STE B
KALISPELL MT
59901-1360
US

V. Phone/Fax

Practice location:
  • Phone: 406-257-8686
  • Fax: 406-257-5770
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number173945
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: