MEDICARE: DR. MARK ROSS COMARATTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	12335	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144286121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ROSS COMARATTA M.D.

Provider Business Mailing Address
First Line	:	1940 W DICKERSON ST
Second Line	:	SUITE 103
City	:	BOZEMAN
State	:	MT
Zip	:	59718-6851
Country	:	US
Telephone Number	:	406-284-2370
Fax Number	:	406-284-2372

Provider Business Practice Location Address
First Line	:	1940 W DICKERSON ST
Second Line	:	SUITE 103
City	:	BOZEMAN
State	:	MT
Zip	:	59718-6851
Country	:	US
Telephone Number	:	406-284-2370
Fax Number	:	406-284-2372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	01/04/2013

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