Healthcare Provider Details

I. General information

NPI: 1396828059
Provider Name (Legal Business Name): ROGER G. SANTALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N 29TH ST
BILLINGS MT
59101-0905
US

IV. Provider business mailing address

931 HIGHLAND BLVD STE 3130
BOZEMAN MT
59715-6914
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-2500
  • Fax:
Mailing address:
  • Phone: 406-414-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number6020
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: