Provider Demographics
NPI:1497260541
Name:BAERMAN, ROBERT ROGER (RD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ROGER
Last Name:BAERMAN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 ELLA AVE # 1
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3717
Mailing Address - Country:US
Mailing Address - Phone:406-231-5802
Mailing Address - Fax:
Practice Address - Street 1:4032 ELLA AVE # 1
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3717
Practice Address - Country:US
Practice Address - Phone:406-231-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-NUTR-LIC-41024133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered