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General NPI Number Information
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NPI Number | 1790902310
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Entity Type | Organization
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Legal Business Name | BOYD M IVERSON
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/28/2008
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Provider Practice Location Address
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Address Line | 110 N OAK ST
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City | TOWNSEND
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State | MT
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Zip | 59644-2306
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Country | US
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Telephone | 406-266-3186
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Fax | 406-266-3180
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Provider Business Mailing Address
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Address Line | 110 N OAK ST
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City | TOWNSEND
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State | MT
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Zip | 59644-2306
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Country | US
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Telephone | 406-266-3186
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Fax | 406-266-3180
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Authorized Official
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Title or Position | OWNER
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Name | DR. DOYD M. IVERSON
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Credential | ORTHOPAEDIC SURGEON
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Telephone | 406-266-3186
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 6096
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License Number State | MT
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