Healthcare Provider Details

I. General information

NPI: 1639539810
Provider Name (Legal Business Name): JON M LYMAN HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S ORANGE ST
MISSOULA MT
59801-1810
US

IV. Provider business mailing address

317 S ORANGE ST
MISSOULA MT
59801-1810
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-1951
  • Fax: 406-542-5682
Mailing address:
  • Phone: 406-549-1951
  • Fax: 406-542-5682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD-HAD-LIC-1211
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: