Individual
TED B. LAINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2825 FORT MISSOULA RD, STE 201, MISSOULA, MT 59804-7420
(406) 721-5566
(406) 728-1868
Mailing address
2825 FORT MISSOULA RD, STE 201, MISSOULA, MT 59804-7420
(406) 721-5566
(406) 728-1868
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
4247
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005-6472
—
MT
01
—
12790
BLUE CROSS/BLUE SHIELD
MT
05
—
1383801
—
WA
Enumeration date
11/29/2005
Last updated
07/08/2007
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