Individual
ALAN A WANDERER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2055 N 22ND AVE, STE 1, BOZEMAN, MT 59718-2783
(406) 582-1111
(406) 582-1112
Mailing address
2055 N 22ND AVE, STE 1, BOZEMAN, MT 59718-2783
(406) 582-1111
(406) 582-1112
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
8795
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0143752
—
MT
Enumeration date
10/13/2005
Last updated
07/08/2007
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