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Individual

WILLIAM KEITH LARA

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
310 SUNNYVIEW LN, EMERGENCY DEPT, KALISPELL, MT 59901-3129
(406) 752-1708
(406) 755-0971
Mailing address
202 CONWAY DR, SUITE 100, KALISPELL, MT 59901-3112
(406) 752-5656
(406) 755-0971

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
7809
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
152677
MT
01
93206
BLUE CROSS
MT
Enumeration date
05/31/2006
Last updated
07/08/2007
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