Individual
JON BRANT MCGREGOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
500 W BROADWAY ST STE 320, MISSOULA, MT 59802-4003
(406) 329-5615
(406) 329-5606
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 329-5615
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
J7580
TX
207RC0000X
Cardiovascular Disease Physician
Primary
MED-PHYS-LIC-89184
MT
207UN0901X
Nuclear Cardiology Physician
J7580
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132066508
—
TX
01
—
P00411171
RAILROAD MEDICARE
TX
Enumeration date
05/04/2006
Last updated
11/09/2021
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