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Organization
BOZEMAN SKIN CLINIC PROFESSIONAL CORPORATION
Active
Organization
BOZEMAN SKIN CLINIC PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN R TKACH MD (PRESIDENT)
(406) 587-5442
Entity
Organization
Contact information
Practice address
300 N WILLSON AVE, SUITE 203B, BOZEMAN, MT 59715-3551
(406) 587-5442
Mailing address
300 N WILLSON AVE, SUITE 203B, BOZEMAN, MT 59715-3551
(406) 587-5442
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
3871
MT
Other
Enumeration date
02/12/2008
Last updated
04/22/2013
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