Individual
MARK S IBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
39 NEILL AVE, HELENA, MT 59601-3330
(406) 513-1052
Mailing address
39 NEILL AVENUE, HELENA, MT 59601
(406) 513-1052
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
7378
MT
207Q00000X
Family Medicine Physician
7378
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104958
—
MT
Enumeration date
06/01/2006
Last updated
10/03/2012
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