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General NPI Number Information
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NPI Number | 1083931067
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Entity Type | Individual
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Provider Name | VICENTE JOSE UNDURRAGA PERL M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 06/03/2025
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Provider Practice Location Address
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Address Line | 500 W BROADWAY ST FL 4
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City | MISSOULA
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State | MT
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Zip | 59802-4008
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Country | US
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Telephone | 406-329-5828
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Fax | 406-329-5864
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Provider Business Mailing Address
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Address Line | PO BOX 31001-4110
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City | PASADENA
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State | CA
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Zip | 91110-4110
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Country | US
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Telephone | 406-329-5828
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Fax | 406-329-5864
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M-14232
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2086S0102X
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Taxonomy Name | Surgical Critical Care Physician
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License Number | MED-PHYS-LIC-113704
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License Number State | MT
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