Healthcare Provider Details

I. General information

NPI: 1104291475
Provider Name (Legal Business Name): ALFRED FLINT DVM, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3934 FRONTAGE RD
THREE FORKS MT
59752-8501
US

IV. Provider business mailing address

3934 FRONTAGE RD
THREE FORKS MT
59752-8501
US

V. Phone/Fax

Practice location:
  • Phone: 406-285-0123
  • Fax: 406-285-6941
Mailing address:
  • Phone: 406-285-0123
  • Fax: 406-285-6941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberMT2045
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: