Provider Demographics
NPI:1174572358
Name:KREBSBACH, EUGENE W (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:W
Last Name:KREBSBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 N 19TH
Mailing Address - Street 2:SUITE A FAMILY DOCTORS' URGENT CARE
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-556-9740
Mailing Address - Fax:406-556-9741
Practice Address - Street 1:120 N 19TH
Practice Address - Street 2:SUITE A FAMILY DOCTORS' URGENT CARE
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-556-9740
Practice Address - Fax:406-556-9741
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT96101OtherBC BS
MT0039763Medicaid
MT96101OtherBC BS