Provider Demographics
NPI:1427077734
Name:BEHM, GREGORY MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:BEHM
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 1:720 LINDSAY LN STE C
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-4143
Mailing Address - Country:US
Mailing Address - Phone:307-578-2180
Mailing Address - Fax:307-578-2181
Practice Address - Street 1:720 LINDSAY LN STE C
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-4143
Practice Address - Country:US
Practice Address - Phone:307-578-2180
Practice Address - Fax:307-578-2181
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14501A207X00000X
MT8555207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0157658Medicaid
MT0016150Medicaid
ND0012988Medicaid
WY215503600Medicaid
MTG92726Medicare UPIN
ND0012988Medicaid
MT010001876Medicare ID - Type UnspecifiedMONTANA MEDICARE