Healthcare Provider Details

I. General information

NPI: 1336218387
Provider Name (Legal Business Name): OSCAR GLENN HEYMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST
MISSOULA MT
59802-4008
US

IV. Provider business mailing address

1985 BIG FLAT RD
MISSOULA MT
59804-9403
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-1670
  • Fax: 406-329-5697
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number10894
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: