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General NPI Number Information
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NPI Number | 1316720162
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Entity Type | Organization
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Legal Business Name | FAMILY DERMATOLOGY PLLC
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Dates
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Enumeration Date | 08/16/2023
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 2835 FORT MISSOULA RD STE 302
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City | MISSOULA
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State | MT
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Zip | 59804-7424
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Country | US
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Telephone | 406-721-3497
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Fax | 406-721-3487
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Provider Business Mailing Address
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Address Line | 1104 ALLENWHITE DR
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City | RICHLAND
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State | WA
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Zip | 99352-9402
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Country | US
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Telephone | 253-948-8165
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN ASSISTANT
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Name | MR. TROY DAVIS
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Credential | PA-C
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Telephone | 253-948-8165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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