Individual
MARK C DEIBERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
536 COTTONWOOD RD, SUITE 100, BOZEMAN, MT 59718
(406) 586-8029
(406) 586-8009
Mailing address
536 COTTONWOOD RD, SUITE 100, BOZEMAN, MT 59718
(406) 586-8029
(406) 586-8009
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
8221
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000104686
—
MT
01
—
01458-1
BCBSMT
MT
01
—
1194070001
CIGNA DME
MT
Enumeration date
07/26/2005
Last updated
10/27/2011
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