Basic Information
| Provider Information | |||||||||
| NPI: | 1790734382 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TEVLIN | ||||||||
| FirstName: | MARJORIE | ||||||||
| MiddleName: | TAYLOR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1233 N 30TH ST | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591010127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062377200 | ||||||||
| FaxNumber: | 4062377263 | ||||||||
| Practice Location | |||||||||
| Address1: | 1233 N 30TH ST | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062377200 | ||||||||
| FaxNumber: | 4062377263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 05/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 8371 | MT | N | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207RC0200X | 8371 | MT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0146458 | 05 | MT | MEDICAID |