Doctor Name: | DR. DANA HEADAPOHL |
NPI Number: | 1962562371 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 5335 |
Business Practice Address: | 601 W Spruce St Suite C Missoula, MT - 598024057 |
Business Phone Number: | 4063292647 |
Business Fax Number: | 4063295606 |
Mailing Address: | 500 W Broadway St, MISSOULA |
State: | MT |
Postal Code: | 598024008 |
Phone Number: | 4063295749 |
Fax Number: | 4063271697 |
NPI Enumeration Date: | 12/08/2006 |
NPI Last Update Date: | 10/31/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 5335 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |