=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821344490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID LAWRENCE EKMAN D.P.M
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2012
-----------------------------------------------------
Last Update Date | 05/20/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3990 AVENUE D
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-7531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-252-5444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3990 AVENUE D
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-7531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-252-5444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | T54-2012
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------