Healthcare Provider Details

I. General information

NPI: 1407878549
Provider Name (Legal Business Name): BRIDGER EAR, NOSE AND THROAT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/07/2023
Certification Date: 12/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 ELLIS ST STE 301
BOZEMAN MT
59715-8811
US

IV. Provider business mailing address

1648 ELLIS ST SUITE 301
BOZEMAN MT
59715-8810
US

V. Phone/Fax

Practice location:
  • Phone: 406-556-9798
  • Fax: 406-556-9795
Mailing address:
  • Phone: 406-556-9798
  • Fax: 406-556-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENNAN DODSON
Title or Position: OWNER
Credential: MD
Phone: 406-556-9798