Provider Demographics
NPI:1164582847
Name:ETTER, HARRY STOUGH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:STOUGH
Last Name:ETTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:188 TERRACE RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7431
Mailing Address - Country:US
Mailing Address - Phone:406-755-1295
Mailing Address - Fax:
Practice Address - Street 1:BLACKFEET COMMUNITY HOSPITAL
Practice Address - Street 2:760 HOSPITAL WAY
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5066207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTD96297Medicare UPIN