Healthcare Provider Details

I. General information

NPI: 1275566754
Provider Name (Legal Business Name): TERRY D DEAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 SOUTH 7650 EAST CROW NORTHERN CHEYENNE INDIAN HOSPITAL
CROW AGENCY MT
59022
US

IV. Provider business mailing address

PO BOX 279
CROW AGENCY MT
59022
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3500
  • Fax: 406-638-3569
Mailing address:
  • Phone: 406-665-2067
  • Fax: 406-638-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number24823
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: