MEDICARE: ROBERT M VALLEAU D.O.

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	207R00000X	Internal Medicine Physician	79001	MT
2	207R00000X	Internal Medicine Physician	R7868	IA
3	207RN0300X	Nephrology Physician	79001	MT

General Provider Information

NPI Number	:	1720298169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT M VALLEAU D.O.

Provider Business Mailing Address
First Line	:	75 CLAREMONT ST STE H
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3500
Country	:	US
Telephone Number	:	406-752-7406
Fax Number	:	406-752-7544

Provider Business Practice Location Address
First Line	:	75 CLAREMONT ST STE H
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3500
Country	:	US
Telephone Number	:	406-752-7406
Fax Number	:	406-752-7544

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	04/19/2021

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