Provider Demographics
NPI:1073504874
Name:FELTON, HARRY (PA)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:FELTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 WENDELL AVE
Mailing Address - Street 2:#103
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2267
Mailing Address - Country:US
Mailing Address - Phone:406-535-1480
Mailing Address - Fax:406-535-1481
Practice Address - Street 1:310 WENDELL AVE
Practice Address - Street 2:#103
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-535-1480
Practice Address - Fax:406-535-1481
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT83363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT438724Medicaid
MT91143OtherBCBX
MT91143OtherBCBX
970022218Medicare ID - Type UnspecifiedRAILROAD MEDICARE
R10639Medicare UPIN