Provider Demographics
NPI:1083710313
Name:OPPER, MINDY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MINDY
Middle Name:
Last Name:OPPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W. KENT ST.
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6619
Mailing Address - Country:US
Mailing Address - Phone:406-240-0604
Mailing Address - Fax:406-721-0055
Practice Address - Street 1:825 W. KENT ST.
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6619
Practice Address - Country:US
Practice Address - Phone:406-721-1646
Practice Address - Fax:406-543-9890
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT37363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0435251Medicaid
MT000081445Medicare ID - Type Unspecified
MT0435251Medicaid