Organization
GLACIER DERMATOLOGY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYLVIA A OWEN MD (PHYSICIAN/OWNER)
(406) 314-6336
Entity
Organization
Contact information
Practice address
40 FOUR MILE DR STE 7, KALISPELL, MT 59901-2655
(406) 314-6336
Mailing address
40 FOUR MILE DR STE 7, KALISPELL, MT 59901-2655
(406) 314-6336
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
10806
MT
207N00000X
Dermatology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0143741
—
MT
Enumeration date
10/03/2017
Last updated
12/12/2017
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