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General NPI Number Information
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NPI Number | 1114108743
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Entity Type | Individual
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Provider Name | MAHMUD SABET SOGGE-KERMANI PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/26/2007
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | RR 1 BOX 67
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City | HARLEM
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State | MT
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Zip | 59526-9705
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Country | US
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Telephone | 406-353-3100
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Fax | 406-353-3229
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Provider Business Mailing Address
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Address Line | RR 1 BOX 67
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City | HARLEM
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State | MT
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Zip | 59526-9705
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Country | US
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Telephone | 406-353-3100
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Fax | 406-353-3229
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 391
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License Number State | MT
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