Healthcare Provider Details

I. General information

NPI: 1922279512
Provider Name (Legal Business Name): NATHAN CHRISTIAN BINGHAM M.D., PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 CONWAY DR
KALISPELL MT
59901-3153
US

IV. Provider business mailing address

202 CONWAY DR
KALISPELL MT
59901-3153
US

V. Phone/Fax

Practice location:
  • Phone: 406-758-7490
  • Fax:
Mailing address:
  • Phone: 406-758-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD50214
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number35.096799
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMD50214
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number44059
License Number StateKY
# 5
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberMED-PHYS-LIC-88230
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: