Provider Demographics
NPI:1720278484
Name:CERISE, TED J JR (OPA-C)
Entity Type:Individual
Prefix:
First Name:TED
Middle Name:J
Last Name:CERISE
Suffix:JR
Gender:M
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N STE 100E
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7504
Mailing Address - Country:US
Mailing Address - Phone:406-238-6700
Mailing Address - Fax:406-238-6734
Practice Address - Street 1:2900 12TH AVE N STE 100E
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7504
Practice Address - Country:US
Practice Address - Phone:406-238-6700
Practice Address - Fax:406-238-6734
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical