Healthcare Provider Details

I. General information

NPI: 1366640484
Provider Name (Legal Business Name): ROBERT YOST-ARCH AMRINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MULLAN RD STE C
MISSOULA MT
59808-1811
US

IV. Provider business mailing address

2360 MULLAN RD STE C
MISSOULA MT
59808-1811
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-4436
  • Fax: 406-721-6053
Mailing address:
  • Phone: 208-367-6042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMR-0925
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-10516
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number12629
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: