Provider Demographics
NPI:1477581916
Name:ROPER, PHILIP A (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:ROPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7706
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7706
Mailing Address - Country:US
Mailing Address - Phone:406-329-2945
Mailing Address - Fax:406-329-2938
Practice Address - Street 1:601 W SPRUCE ST STE A
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4047
Practice Address - Country:US
Practice Address - Phone:406-329-2945
Practice Address - Fax:406-329-2938
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9709207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0041378Medicaid
MT0034119Medicaid
MT0041378Medicaid
MTD37535Medicare UPIN
MT000081826Medicare PIN