Provider Demographics
NPI:1710963517
Name:BERBOS, THOMAS GIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GIAN
Last Name:BERBOS
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 1:301 SADDLE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601
Mailing Address - Country:US
Mailing Address - Phone:406-442-3937
Mailing Address - Fax:406-442-3366
Practice Address - Street 1:301 SADDLE DR
Practice Address - Street 2:SUITE B
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-442-3937
Practice Address - Fax:406-442-3366
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10805207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02304823Medicaid
NYCC5084Medicare ID - Type Unspecified
NY02304823Medicaid