Provider Demographics
NPI:1972874048
Name:BAMFORD, BOBBIE SUE (LMT NCTMB)
Entity Type:Individual
Prefix:MS
First Name:BOBBIE
Middle Name:SUE
Last Name:BAMFORD
Suffix:
Gender:F
Credentials:LMT NCTMB
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 180
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-0180
Mailing Address - Country:US
Mailing Address - Phone:406-291-3056
Mailing Address - Fax:
Practice Address - Street 1:412 W 3RD ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-1754
Practice Address - Country:US
Practice Address - Phone:406-291-3056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-22
Last Update Date:2012-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1168174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty