MEDICARE: DR. ALFRED ESTIN AVERY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	10258	MT

General Provider Information

NPI Number	:	1063587426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED ESTIN AVERY M.D.

Provider Business Mailing Address
First Line	:	2807 1ST AVE N
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-2311
Country	:	US
Telephone Number	:	406-896-0483
Fax Number	:	406-259-9479

Provider Business Practice Location Address
First Line	:	2807 1ST AVE N
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59101-2311
Country	:	US
Telephone Number	:	406-896-0483
Fax Number	:	406-259-9479

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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