Provider Demographics
NPI:1760540579
Name:LEMLEY, ROBERT WADE (ND)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WADE
Last Name:LEMLEY
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 W MAIN ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3815
Mailing Address - Country:US
Mailing Address - Phone:406-585-0205
Mailing Address - Fax:
Practice Address - Street 1:2411 W MAIN ST STE 1A
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3815
Practice Address - Country:US
Practice Address - Phone:406-585-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1000619664107175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT89678OtherBC NUMBER