Provider Demographics
NPI:1568449411
Name:PEZZAROSSI, PATRICIA JUNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:JUNE
Last Name:PEZZAROSSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S WINCHESTER AVE
Mailing Address - Street 2:136
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-4742
Mailing Address - Country:US
Mailing Address - Phone:406-234-8793
Mailing Address - Fax:406-234-8796
Practice Address - Street 1:210 S WINCHESTER AVE
Practice Address - Street 2:136
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-4742
Practice Address - Country:US
Practice Address - Phone:406-234-8793
Practice Address - Fax:406-234-8796
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6252208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTA02041Medicare UPIN