Healthcare Provider Details

I. General information

NPI: 1508082892
Provider Name (Legal Business Name): HEATHER L BORDERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1648 ELLIS ST STE 201
BOZEMAN MT
59715-8811
US

IV. Provider business mailing address

1648 ELLIS ST STE 201
BOZEMAN MT
59715-8811
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-8631
  • Fax: 406-587-1343
Mailing address:
  • Phone: 406-587-8631
  • Fax: 406-587-1343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMED-PHYS-LIC-69139
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number333034
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMED-PHYS-LIC-69139
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301081598
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: