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Individual

JEFFREY BARILLA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LMT

Contact information

Practice address
1116 S RUSSELL ST, MISSOULA, MT 59801-3511
(406) 541-1525
Mailing address
1116 S RUSSELL ST, MISSOULA, MT 59801-3511
(406) 541-1525

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
LMT-LMT-LIC-3118
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
BE
BE
MT
Enumeration date
11/04/2013
Last updated
11/04/2013
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