Provider Demographics
NPI:1063621985
Name:MCGINNIS, ROBERT OWEN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:OWEN
Last Name:MCGINNIS
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 1:1575 W KAGY BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6509
Mailing Address - Country:US
Mailing Address - Phone:406-522-9355
Mailing Address - Fax:
Practice Address - Street 1:1575 W KAGY BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6509
Practice Address - Country:US
Practice Address - Phone:406-522-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10123207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT10123OtherSTATE MEDICAL LICENSE
C34661Medicare UPIN