MEDICARE: MARK C DEIBERT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	8221	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01458-1	OTHER	MT	BCBSMT
2	1194070001	OTHER	MT	CIGNA DME
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437159944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK C DEIBERT MD

Provider Business Mailing Address
First Line	:	536 COTTONWOOD RD
Second Line	:	SUITE 100
City	:	BOZEMAN
State	:	MT
Zip	:	59718
Country	:	US
Telephone Number	:	406-586-8029
Fax Number	:	406-586-8009

Provider Business Practice Location Address
First Line	:	536 COTTONWOOD RD
Second Line	:	SUITE 100
City	:	BOZEMAN
State	:	MT
Zip	:	59718
Country	:	US
Telephone Number	:	406-586-8029
Fax Number	:	406-586-8009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	10/27/2011

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Directions to “ MARK C DEIBERT MD” Practice Location

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