Provider Demographics
NPI:1114169836
Name:ST. JOHN, ROBERT MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:ST. JOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2500 CONTINENTAL DRIVE
Mailing Address - Street 2:MONTANA CHEMICAL DEPENDENCY CENTER
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-0000
Mailing Address - Country:US
Mailing Address - Phone:406-496-5400
Mailing Address - Fax:406-496-5437
Practice Address - Street 1:2500 CONTINENTAL DRIVE
Practice Address - Street 2:MONTANA CHEMICAL DEPENDENCY CENTER
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-0000
Practice Address - Country:US
Practice Address - Phone:406-496-5400
Practice Address - Fax:406-496-5437
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3194207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTAS2040993OtherDEA