Individual
THEODORE J CHASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
2600 WILSON STREET, MILES CITY, MT 59301
(406) 233-2600
(406) 233-2611
Mailing address
PO BOX 1412, MILES CITY, MT 59301
(406) 459-6060
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
469
MT
363AM0700X
Medical Physician Assistant
PA-577
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9970976
—
MT
Enumeration date
01/26/2006
Last updated
11/06/2007
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