Healthcare Provider Details

I. General information

NPI: 1417061524
Provider Name (Legal Business Name): ALAN H ORAM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9030 RED MOUNTAIN WAY
VICTOR ID
83455-5498
US

IV. Provider business mailing address

9030 RED MOUNTAIN WAY
VICTOR ID
83455-5498
US

V. Phone/Fax

Practice location:
  • Phone: 406-581-2902
  • Fax:
Mailing address:
  • Phone: 406-581-2902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number6096A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: