Healthcare Provider Details

I. General information

NPI: 1568449411
Provider Name (Legal Business Name): PATRICIA JUNE PEZZAROSSI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S WINCHESTER AVE 136
MILES CITY MT
59301-4742
US

IV. Provider business mailing address

210 S WINCHESTER AVE 136
MILES CITY MT
59301-4742
US

V. Phone/Fax

Practice location:
  • Phone: 406-234-8793
  • Fax: 406-234-8796
Mailing address:
  • Phone: 406-234-8793
  • Fax: 406-234-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6252
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: