Provider Demographics
NPI:1932177656
Name:BOZEMAN UROLOGICAL ASSOCIATES
Entity Type:Organization
Organization Name:BOZEMAN UROLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-596-2516
Mailing Address - Street 1:935 HIGHLAND BLVD
Mailing Address - Street 2:SUITE 2160
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6904
Mailing Address - Country:US
Mailing Address - Phone:406-586-2516
Mailing Address - Fax:406-586-0048
Practice Address - Street 1:935 HIGHLAND BLVD
Practice Address - Street 2:SUITE 2160
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6904
Practice Address - Country:US
Practice Address - Phone:406-586-2516
Practice Address - Fax:406-586-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7537174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTF82255Medicare UPIN