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General NPI Number Information
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NPI Number | 1972035632
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Entity Type | Individual
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Provider Name | OTABEK ELMURODOV M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2017
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Last Update Date | 10/12/2020
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Provider Practice Location Address
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Address Line | 760 HOSPITAL CIRCLE 7 NEW HOSPITAL CIRCLE
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City | BROWNING
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State | MT
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Zip | 59417-5941
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Country | US
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Telephone | 406-338-8903
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 7650 E
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City | CROW AGENCY
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State | MT
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Zip | 59022
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Country | US
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Telephone | 206-335-0684
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 081428
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License Number State | GA
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