Individual
MR. KENNETH BOGART
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
323 W ALDER ST, MISSOULA, MT 59802-4123
(406) 258-4191
(406) 258-4180
Mailing address
323 W ALDER ST, MISSOULA, MT 59802-4123
(406) 258-4191
(406) 258-4180
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
28
MT
Other
Enumeration date
06/02/2006
Last updated
07/08/2007
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