Provider Demographics
NPI:1821248089
Name:GERENA MALDONADO, ELBA YESI (MD)
Entity Type:Individual
Prefix:
First Name:ELBA
Middle Name:YESI
Last Name:GERENA MALDONADO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 LARAMIE DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-2005
Mailing Address - Country:US
Mailing Address - Phone:406-587-0122
Mailing Address - Fax:844-656-2480
Practice Address - Street 1:3400 LARAMIE DR
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-2005
Practice Address - Country:US
Practice Address - Phone:406-587-0122
Practice Address - Fax:844-656-2480
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL1409922081N0008X
PR183322081N0008X
MTMED-PHYS-LIC-1140932081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1821248089Medicaid
WA1821248089Medicaid