Healthcare Provider Details

I. General information

NPI: 1053671792
Provider Name (Legal Business Name): BLYTHE KAUFMANN BELZER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2012
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST FL 4
MISSOULA MT
59802
US

IV. Provider business mailing address

500 W BROADWAY ST FL 4
MISSOULA MT
59802-4008
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-1900
  • Fax: 406-327-1974
Mailing address:
  • Phone: 406-327-1900
  • Fax: 406-327-1974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number62041-20
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number76930
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: