Healthcare Provider Details

I. General information

NPI: 1891817011
Provider Name (Legal Business Name): BOZEMAN FOOT AND ANKLE CLINIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 05/30/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E MAIN ST STE 2
BOZEMAN MT
59715-3823
US

IV. Provider business mailing address

1050 E MAIN ST STE 2
BOZEMAN MT
59715-3823
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-8478
  • Fax: 406-582-0730
Mailing address:
  • Phone: 406-587-8478
  • Fax: 406-582-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number129
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRENDA NARANJO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 406-587-8478