Individual
JASON THOMAS ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1648 ELLIS ST STE 201, BOZEMAN, MT 59715-8811
(406) 587-8631
(406) 587-1343
Mailing address
1648 ELLIS ST STE 201, BOZEMAN, MT 59715-8811
(406) 587-8631
(406) 587-1343
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
MED-PHYS-LIC-76665
MT
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/01/2013
Last updated
10/08/2020
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