Provider Demographics
NPI:1265479521
Name:ERB, BLAIR DILLARD JR (MD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:DILLARD
Last Name:ERB
Suffix:JR
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 1:937 HIGHLAND BLVD
Mailing Address - Street 2:STE 5510
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6909
Mailing Address - Country:US
Mailing Address - Phone:406-414-3959
Mailing Address - Fax:
Practice Address - Street 1:905 HIGHLAND BLVD
Practice Address - Street 2:SUITE 4330
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6902
Practice Address - Country:US
Practice Address - Phone:406-522-3959
Practice Address - Fax:406-586-5941
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8678207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0048360Medicaid
MT000082698Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE #
MT0048360Medicaid