Healthcare Provider Details

I. General information

NPI: 1215909049
Provider Name (Legal Business Name): JAMES DOUGLAS BOZEMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W PORPHYRY ST SUITE 200
BUTTE MT
59701-2000
US

IV. Provider business mailing address

305 W PORPHYRY ST SUITE 200
BUTTE MT
59701-2000
US

V. Phone/Fax

Practice location:
  • Phone: 406-496-3627
  • Fax: 406-723-2495
Mailing address:
  • Phone: 406-496-3627
  • Fax: 406-723-2495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9220
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number7546
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: