Provider Demographics
NPI:1215998505
Name:TICE, HOWARD LINCOLN (MD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:LINCOLN
Last Name:TICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:75 CLAREMONT ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3585
Mailing Address - Country:US
Mailing Address - Phone:406-752-7441
Mailing Address - Fax:406-257-0304
Practice Address - Street 1:75 CLAREMONT ST
Practice Address - Street 2:SUITE F
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3585
Practice Address - Country:US
Practice Address - Phone:406-752-7441
Practice Address - Fax:406-257-0304
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT10070207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT46597Medicaid
MTA58742Medicare UPIN
MT46597Medicaid