Individual
DOMINICK PETER TRIVISONNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
202 SOUTH 4TH STREET WEST, BAKER, MT 59313-1119
(406) 778-2833
(406) 778-5131
Mailing address
PO BOX 1119, BAKER, MT 59313-1119
(406) 778-2833
(406) 778-5131
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
11857
MT
208D00000X
General Practice Physician
Primary
173465
NY
Other
Enumeration date
04/15/2008
Last updated
01/30/2012
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