Basic Information
| Provider Information | |||||||||
| NPI: | 1477033793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCLAFFERTY | ||||||||
| FirstName: | MICAUL | ||||||||
| MiddleName: | CASSIDY | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3636 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | BUTTE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597013571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064963600 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 435 S CRYSTAL ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | BUTTE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 597011506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064963600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2018 | ||||||||
| LastUpdateDate: | 02/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 69428 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.