Provider Demographics
NPI:1043329964
Name:ROTTENBILLER, RANDOLPH I (MD)
Entity Type:Individual
Prefix:
First Name:RANDOLPH
Middle Name:I
Last Name:ROTTENBILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 258
Mailing Address - Street 2:
Mailing Address - City:EAST GLACIER PARK
Mailing Address - State:MT
Mailing Address - Zip Code:59434-0258
Mailing Address - Country:US
Mailing Address - Phone:406-338-6202
Mailing Address - Fax:406-339-6237
Practice Address - Street 1:760 GOVT. CIRCLE
Practice Address - Street 2:BLACKFEET COMMUNITY HOSPITAL
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-6202
Practice Address - Fax:406-338-2437
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2210052Medicaid
MT2210052Medicaid
MTH47331Medicare UPIN