Provider Demographics
NPI:1225652001
Name:TALAWYMA, JOHNNY L JR (BBH-BHPS-CRT-42875)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:L
Last Name:TALAWYMA
Suffix:JR
Gender:M
Credentials:BBH-BHPS-CRT-42875
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 N 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2303
Mailing Address - Country:US
Mailing Address - Phone:406-598-9013
Mailing Address - Fax:
Practice Address - Street 1:1230 N. 30TH ST. SUITE 100
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-534-4558
Practice Address - Fax:406-290-7450
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT42875175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist