Individual
CASEY AMBROSE
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
Mailing address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 327-1918
(406) 549-2246
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
53219
MT
207P00000X
Emergency Medicine Physician
MED-PHYS-LIC-53219
MT
390200000X
Student in an Organized Health Care Education/Training Program
RS2014-0357
NM
Other
Enumeration date
04/17/2014
Last updated
10/06/2017
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