Provider Demographics
NPI:1356661052
Name:LAURENCE V. AYRES, MD, PC
Entity Type:Organization
Organization Name:LAURENCE V. AYRES, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:V
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-360-8757
Mailing Address - Street 1:PO BOX 8778
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-8778
Mailing Address - Country:US
Mailing Address - Phone:406-327-9772
Mailing Address - Fax:406-327-9772
Practice Address - Street 1:1605 SNOW BOWL RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9350
Practice Address - Country:US
Practice Address - Phone:406-549-8757
Practice Address - Fax:406-549-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5030207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000074321Medicaid