Healthcare Provider Details

I. General information

NPI: 1073504874
Provider Name (Legal Business Name): HARRY FELTON P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 WENDELL AVE #103
LEWISTOWN MT
59457-2267
US

IV. Provider business mailing address

310 WENDELL AVE #103
LEWISTOWN MT
59457-2267
US

V. Phone/Fax

Practice location:
  • Phone: 406-535-1480
  • Fax: 406-535-1481
Mailing address:
  • Phone: 406-535-1480
  • Fax: 406-535-1481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number83
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: