Doctor Name: | TED B. LAINE |
NPI Number: | 1043294572 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 4247 |
Business Practice Address: | 2825 Fort Missoula Rd Ste 201 Missoula, MT - 598047420 |
Business Phone Number: | 4067215566 |
Business Fax Number: | 4067281868 |
Mailing Address: | 2825 Fort Missoula Rd, Ste 201 MISSOULA |
State: | MT |
Postal Code: | 598047420 |
Phone Number: | 4067215566 |
Fax Number: | 4067281868 |
NPI Enumeration Date: | 11/29/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 4247 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |