Provider Demographics
NPI:1285660514
Name:WEISSER VIOLETT, JODI L (MD)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:L
Last Name:WEISSER VIOLETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:L
Other - Last Name:VIOLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:401 15TH AVE S #201
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-727-2121
Mailing Address - Fax:406-727-2147
Practice Address - Street 1:401 15TH AVE S #201
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-727-2121
Practice Address - Fax:406-727-2147
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT9852207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTH44256Medicare UPIN