Provider Demographics
NPI:1962775411
Name:JOHN A. VALLIN, M.D., LLC
Entity type:Organization
Organization Name:JOHN A. VALLIN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-223-2497
Mailing Address - Street 1:85 BRANDON TRAIL RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-1707
Mailing Address - Country:US
Mailing Address - Phone:406-223-2497
Mailing Address - Fax:406-586-6867
Practice Address - Street 1:85 BRANDON TRAIL RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-1707
Practice Address - Country:US
Practice Address - Phone:406-223-2497
Practice Address - Fax:406-586-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT80702081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT22491Medicaid
MT81448Medicare PIN
MTE82792Medicare UPIN