Individual
JACOB MICHAEL TAVERNA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
435 S CRYSTAL ST, SUITE 300, BUTTE, MT 59701-1506
(406) 496-3600
(406) 496-3653
Mailing address
435 S CRYSTAL ST, SUITE 300, BUTTE, MT 59701-1506
(406) 496-3600
(406) 496-3653
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
7657
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006 4818
—
MT
Enumeration date
11/15/2005
Last updated
01/21/2008
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