Provider Demographics
NPI:1154465839
Name:OCHENRIDER, MARK G (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:OCHENRIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1287 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3109
Mailing Address - Country:US
Mailing Address - Phone:406-752-8120
Mailing Address - Fax:406-752-8134
Practice Address - Street 1:1287 BURNS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3109
Practice Address - Country:US
Practice Address - Phone:406-752-8120
Practice Address - Fax:406-752-8134
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-48391207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8519944Medicaid
WA8519944Medicaid
WAG8874482Medicare PIN