Individual
COTY JOHN HOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 329-5615
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(406) 329-5615
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
MED-PAC-LIC-91036
MT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/23/2019
Last updated
05/21/2021
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