Healthcare Provider Details

I. General information

NPI: 1386730893
Provider Name (Legal Business Name): WILLIAM ALLEN SURBER II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 STOCKYARD RD BLDG I-200
MISSOULA MT
59808-1503
US

IV. Provider business mailing address

122 DALY AVE
MISSOULA MT
59801-4212
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-8420
  • Fax: 406-541-8430
Mailing address:
  • Phone: 406-549-3206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25595
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number11721
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number11721
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: