Organization
MISSOULA OSTEOPATHIC CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAM ARON WALLACE D.O. (OWNER/PHYSICIAN)
(406) 327-0269
Entity
Organization
Contact information
Practice address
341 W PINE ST, MISSOULA, MT 59802-4119
(406) 327-0269
(406) 327-0264
Mailing address
341 W PINE ST, MISSOULA, MT 59802-4119
(406) 327-0269
(406) 327-0264
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MED-PHYS-LIC-8667
MT
Other
Enumeration date
06/21/2013
Last updated
11/10/2022
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