Healthcare Provider Details

I. General information

NPI: 1043206238
Provider Name (Legal Business Name): WARING TRIBLE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S COTTONWOOD RD STE 200
BOZEMAN MT
59718-4222
US

IV. Provider business mailing address

915 HIGHLAND BLVD ATTN: PAYER CREDENTIALING
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-1826
  • Fax: 406-414-1071
Mailing address:
  • Phone: 406-414-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0101042665
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number81148
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: