Individual
JANICE R GOMERSALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2835 FORT MISSOULA RD, MISSOULA, MT 59804-7423
(406) 327-3920
Mailing address
PO BOX 16900, MISSOULA, MT 59808-6900
(406) 327-4620
(406) 549-5928
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
8087
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801831599
—
MT
Enumeration date
06/18/2006
Last updated
06/16/2008
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