Provider Demographics
NPI:1861676744
Name:FALKENBURG, NEIL EDGAR (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:EDGAR
Last Name:FALKENBURG
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:PO BOX 1629
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-1629
Mailing Address - Country:US
Mailing Address - Phone:406-570-8405
Mailing Address - Fax:
Practice Address - Street 1:14 SIDEHILL TRAIL
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729
Practice Address - Country:US
Practice Address - Phone:406-570-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT95562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTA04451Medicare UPIN