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Individual

MARK WRAY KORMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
107 H STREET EAST, POPLAR, MT 59255-0067
(406) 768-3491
(406) 768-5109
Mailing address
PO BOX 67, 107 H STREET EAST, POPLAR, MT 59201-0067
(406) 768-3491
(406) 768-5109

Taxonomy

Speciality
Code
Description
License number
State
246QM0706X
Medical Technologist
Primary
958
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9990118
MT
01
WV-958
LICENSE
WV
Enumeration date
04/16/2013
Last updated
04/17/2013
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