Individual
ALLAN R SUPAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
320 ALPENGLOW LANE, LIVINGSTON, MT 59047
(406) 823-6414
(406) 823-6287
Mailing address
320 ALPENGLOW LANE, LIVINGSTON, MT 59047
(406) 823-6414
(406) 823-6287
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
8521
MT
207Q00000X
Family Medicine Physician
Primary
8521
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000018171
BLUECROSSBLUESHIELD
MT
05
—
0014110
—
MT
Enumeration date
08/29/2006
Last updated
12/09/2015
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