Healthcare Provider Details

I. General information

NPI: 1093745572
Provider Name (Legal Business Name): DARRYL M ESPELAND DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SOUTH 4TH STREET WEST
BAKER MT
59313-1119
US

IV. Provider business mailing address

PO BOX 1119
BAKER MT
59313-1119
US

V. Phone/Fax

Practice location:
  • Phone: 406-778-2833
  • Fax: 406-778-5131
Mailing address:
  • Phone: 406-778-2833
  • Fax: 406-778-5131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number6291
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: