Provider Demographics
NPI:1811919673
Name:SONNENBERG, LARRY W (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:W
Last Name:SONNENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:931 HIGHLAND BLVD
Mailing Address - Street 2:SUITE 3360
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715
Mailing Address - Country:US
Mailing Address - Phone:406-587-4242
Mailing Address - Fax:406-587-3507
Practice Address - Street 1:931 HIGHLAND BLVD
Practice Address - Street 2:SUITE 3360
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715
Practice Address - Country:US
Practice Address - Phone:406-587-4242
Practice Address - Fax:406-587-3507
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT6146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0103415Medicaid
MT00838OtherBCBS OF MONTANA
D08008Medicare UPIN