Provider Demographics
NPI:1992794010
Name:DANAHER, PATRICK ROBERT (DO)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:ROBERT
Last Name:DANAHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17377
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-7377
Mailing Address - Country:US
Mailing Address - Phone:406-728-8420
Mailing Address - Fax:
Practice Address - Street 1:2835 FORT MISSOULA RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7423
Practice Address - Country:US
Practice Address - Phone:406-728-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10695207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807048100Medicaid
MT0087176Medicaid
MT0087176Medicaid
G17754Medicare UPIN