Healthcare Provider Details

I. General information

NPI: 1790902310
Provider Name (Legal Business Name): BOYD M IVERSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N OAK ST
TOWNSEND MT
59644-2306
US

IV. Provider business mailing address

110 N OAK ST
TOWNSEND MT
59644-2306
US

V. Phone/Fax

Practice location:
  • Phone: 406-266-3186
  • Fax: 406-266-3180
Mailing address:
  • Phone: 406-266-3186
  • Fax: 406-266-3180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number6096
License Number StateMT

VIII. Authorized Official

Name: DR. DOYD M. IVERSON
Title or Position: OWNER
Credential: ORTHOPAEDIC SURGEON
Phone: 406-266-3186