Provider Demographics
NPI:1396828059
Name:SANTALA, ROGER G (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:G
Last Name:SANTALA
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 1:931 HIGHLAND BLVD
Mailing Address - Street 2:STE 3130
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6914
Mailing Address - Country:US
Mailing Address - Phone:406-414-5070
Mailing Address - Fax:
Practice Address - Street 1:801 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0905
Practice Address - Country:US
Practice Address - Phone:406-238-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6020207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000093730OtherBCBS PIN
WY307896OtherBCBS PIN
ND17622OtherND BCBS
WY101060300OtherMDCD PIN
MT0109408OtherMDCD PIN
MT000080863Medicare PIN
WYW307896Medicare PIN
MT000093730OtherBCBS PIN
MT000080976Medicare PIN
NDN17622Medicare PIN
WY307896OtherBCBS PIN
MT0109408OtherMDCD PIN