MEDICARE: DR. PATTI A STATES 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	207Q00000X	Family Medicine Physician	6720	MT

General Provider Information

NPI Number	:	1891177499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATTI A STATES M.D.

Provider Business Mailing Address
First Line	:	1328 5TH AVE
Second Line	:
City	:	LAUREL
State	:	MT
Zip	:	59044-9632
Country	:	US
Telephone Number	:	406-545-9718
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 POLY DR
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-1739
Country	:	US
Telephone Number	:	406-657-1190
Fax Number	:

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

Provider Enumeration Date	:	06/19/2015
Last Update Date	:	06/19/2015

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