Individual
DR. EDRED T VIZCARRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
126 6TH AVE SW, RONAN, MT 59864-2600
(406) 676-3600
(406) 676-3738
Mailing address
48767 ROCKY BUTTE RD, RONAN, MT 59864-8897
(406) 676-0432
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6860
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101257
—
MT
Enumeration date
12/19/2006
Last updated
07/08/2007
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