Individual
JACK TOWER BRANSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 329-5635
(406) 327-2160
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 329-5635
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
11420196-1205
UT
207P00000X
Emergency Medicine Physician
Primary
MED-PHYS-LIC-96286
MT
Other
Enumeration date
04/05/2018
Last updated
11/11/2021
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