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General NPI Number Information
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NPI Number | 1134360126
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Entity Type | Individual
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Provider Name | JOEL CHARLES RUTHERFORD D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 03/20/2009
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Last Update Date | 11/22/2011
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Provider Practice Location Address
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Address Line | 77 LILY VALLEY CIR
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City | BILLINGS
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State | MT
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Zip | 59105-2368
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Country | US
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Telephone | 406-839-8676
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Fax |
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Provider Business Mailing Address
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Address Line | 32 30TH ST W
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City | BILLINGS
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State | MT
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Zip | 59102-6632
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Country | US
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Telephone | 406-839-8676
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Fax |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 170
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License Number State | MT
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