Provider Demographics
NPI:1952067100
Name:KAVRAN, THOMAS JACOB
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JACOB
Last Name:KAVRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 DEARBORN AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8035
Mailing Address - Country:US
Mailing Address - Phone:406-396-5232
Mailing Address - Fax:406-543-0656
Practice Address - Street 1:1902 BROOKS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6644
Practice Address - Country:US
Practice Address - Phone:406-728-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT55043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist