MEDICARE: DR. GLENN J JARRETT 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	207X00000X	Orthopaedic Surgery Physician	8469	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356320246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN J JARRETT M.D.

Provider Business Mailing Address
First Line	:	2360 MULLAN RD
Second Line	:	SUITE C
City	:	MISSOULA
State	:	MT
Zip	:	59808-1811
Country	:	US
Telephone Number	:	406-721-4436
Fax Number	:	406-721-6053

Provider Business Practice Location Address
First Line	:	2360 MULLAN RD
Second Line	:	SUITE C
City	:	MISSOULA
State	:	MT
Zip	:	59808-1811
Country	:	US
Telephone Number	:	406-721-4436
Fax Number	:	406-721-6053

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	12/03/2019

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