MEDICARE: DAVID DUCHARME

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	2255A2300X	Athletic Trainer	ATR-LAT-LIC-676	MT

General Provider Information

NPI Number	:	1245629211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DUCHARME

Provider Business Mailing Address
First Line	:	6325 BLACKFOOT DR
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59602-6516
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 N MONTANA AVE STE A
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59602-7804
Country	:	US
Telephone Number	:	406-422-5817
Fax Number	:	406-422-5928

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

Provider Enumeration Date	:	01/14/2015
Last Update Date	:	01/14/2015

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Directions to “ DAVID DUCHARME ” Practice Location

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