Healthcare Provider Details

I. General information

NPI: 1467490375
Provider Name (Legal Business Name): PATRICK S. MAIDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/13/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N RUSSELL ST
MISSOULA MT
59801-1704
US

IV. Provider business mailing address

140 N RUSSELL ST
MISSOULA MT
59801-1704
US

V. Phone/Fax

Practice location:
  • Phone: 406-532-9700
  • Fax:
Mailing address:
  • Phone: 406-532-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD13937
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number69960
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: