Individual
G GREGG NEIBAUER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1845 BANCROFT ST, MISSOULA, MT 59801-5747
(406) 721-4007
(406) 549-9807
Mailing address
1845 BANCROFT ST, MISSOULA, MT 59801-5747
(406) 721-4007
(406) 549-9807
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
160
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000084041
MEDICARE GROUP PIN
MT
05
—
0390779
—
MT
01
—
97315
BLUE CROSS BLUE SHIELD
MT
01
—
P00097318
RAILROAD MEDICARE
MT
Enumeration date
11/01/2007
Last updated
04/07/2014
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