Healthcare Provider Details

I. General information

NPI: 1407806987
Provider Name (Legal Business Name): KATHERINE LEE MARKETTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST RADIATION ONCOLOGY/ST PATRICK HOSPITAL
MISSOULA MT
59802-4003
US

IV. Provider business mailing address

PO BOX 4587 SAINT PATRICK HOSPITAL 500 W BROADWAY
MISSOULA MT
59806-4587
US

V. Phone/Fax

Practice location:
  • Phone: 406-329-5655
  • Fax: 406-329-5675
Mailing address:
  • Phone: 406-329-5655
  • Fax: 406-329-5675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number5186
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: