Individual
DR. ANDREW W GRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
925 HIGHLAND BLVD STE 1200, BOZEMAN, MT 59715-6900
(406) 414-4550
Mailing address
915 HIGHLAND BLVD, BOZEMAN, MT 59715-6902
(406) 414-5000
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
10338
MT
208600000X
Surgery Physician
Primary
10338
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0062917
—
MT
01
—
45-2860317
TAX ID
MT
Enumeration date
06/17/2005
Last updated
04/15/2025
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