MEDICARE: JACOB WHETZEL

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	207Q00000X	Family Medicine Physician	70836	MT

General Provider Information

NPI Number	:	1548655368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB WHETZEL

Provider Business Mailing Address
First Line	:	1208 6TH AVE
Second Line	:
City	:	SUPERIOR
State	:	MT
Zip	:	59872-9667
Country	:	US
Telephone Number	:	406-822-4801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1208 6TH AVE
Second Line	:
City	:	SUPERIOR
State	:	MT
Zip	:	59872-9667
Country	:	US
Telephone Number	:	406-822-4801
Fax Number	:

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

Provider Enumeration Date	:	03/30/2015
Last Update Date	:	09/05/2025

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Directions to “ JACOB WHETZEL ” Practice Location

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