Individual
DR. CHARLES D JENNINGS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
500 15TH AVE S, SUITE 1, GREAT FALLS, MT 59405-4324
(406) 455-3650
(406) 455-3695
Mailing address
500 15TH AVE S, SUITE 1, GREAT FALLS, MT 59405-4324
(406) 455-3650
(406) 455-3695
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
3805
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000780
BLUE CROSS BLUE SHIELD
MT
01
—
0012575
WASHINGTON L&I
MT
05
—
0019201
—
MT
01
—
020013476
RAILROAD MEDICARE
MT
01
—
184609700
FEDERAL WORK COMP
MT
Enumeration date
06/26/2006
Last updated
05/28/2008
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