Individual
JACK H AVERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RT (R) (MRI)(QM)(CT)
Contact information
Practice address
3510 PTARMIGAN LN, HELENA, MT 59602-0553
(406) 449-3750
(406) 449-3752
Mailing address
PO BOX 5179, HELENA, MT 59604-5179
(406) 449-3750
(406) 449-3752
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
1019
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0760123
—
MT
Enumeration date
10/24/2006
Last updated
11/16/2007
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