Provider Demographics
NPI:1417480542
Name:FOGEL, NATHANIEL WILCOX (MD, MS)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:WILCOX
Last Name:FOGEL
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:NATHANIEL
Other - Middle Name:DAVID
Other - Last Name:WILCOX-FOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 HERITAGE WAY STE 1200
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 HERITAGE WAY STE 1200
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3160
Practice Address - Country:US
Practice Address - Phone:406-752-6784
Practice Address - Fax:406-756-4111
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-05
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-118833207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery