Provider Demographics
NPI:1134296445
Name:AMMONS, ROBERT BRUCE III (PH D)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRUCE
Last Name:AMMONS
Suffix:III
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 FORT MISSOULA ROAD
Mailing Address - Street 2:COMMUNITY PHYSICIANS CENTER #2 SUITE 201
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804
Mailing Address - Country:US
Mailing Address - Phone:406-728-8818
Mailing Address - Fax:406-327-4552
Practice Address - Street 1:2831 FORT MISSOULA ROAD
Practice Address - Street 2:COMMUNITY PHYSICIANS CENTER #2 SUITE 201
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804
Practice Address - Country:US
Practice Address - Phone:406-728-8818
Practice Address - Fax:406-327-4552
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT374103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical