Provider Demographics
NPI:1104963610
Name:COOLIDGE, DEL BREMER (MD)
Entity type:Individual
Prefix:
First Name:DEL
Middle Name:BREMER
Last Name:COOLIDGE
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 1:1850 FOUR WHEEL DR
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8021
Mailing Address - Country:US
Mailing Address - Phone:406-862-7606
Mailing Address - Fax:406-873-5675
Practice Address - Street 1:519 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-3015
Practice Address - Country:US
Practice Address - Phone:406-873-5670
Practice Address - Fax:406-873-5675
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3569MD207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTAB10254Medicare ID - Type Unspecified
MTC64092Medicare UPIN