| Doctor Name: | DOMINICK PETER TRIVISONNO |
| NPI Number: | 1235303801 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 11857 |
| Business Practice Address: | 202 South 4th Street West Baker, MT - 593131119 |
| Business Phone Number: | 4067782833 |
| Business Fax Number: | 4067785131 |
| Mailing Address: | Po Box 1119, BAKER |
| State: | MT |
| Postal Code: | 593131119 |
| Phone Number: | 4067782833 |
| Fax Number: | 4067785131 |
| NPI Enumeration Date: | 04/15/2008 |
| NPI Last Update Date: | 01/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 11857 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |