Provider Demographics
NPI:1841241346
Name:ROSENTHAL, JON EVAN (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:EVAN
Last Name:ROSENTHAL
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 1:1232 N 15TH AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3299
Mailing Address - Country:US
Mailing Address - Phone:406-518-1598
Mailing Address - Fax:406-587-7742
Practice Address - Street 1:1232 N 15TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3299
Practice Address - Country:US
Practice Address - Phone:406-518-1598
Practice Address - Fax:406-587-7742
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT34594261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX180501221Medicaid
TX180501207Medicaid
TX180501209Medicaid
TX180501210Medicaid
TX180501208Medicaid
TX180501208Medicaid
TX8J6959Medicare PIN
TXP00385693Medicare PIN
TX8G9054Medicare PIN
TX8G9056Medicare PIN
TX180501221Medicaid
TX8G9703Medicare PIN
TX180501209Medicaid
TX8G9058Medicare PIN
TX8G9702Medicare PIN
TX8J0523Medicare PIN
TX8G9700Medicare PIN
TX180501210Medicaid
TX8G9057Medicare PIN
TX8G9701Medicare PIN