Healthcare Provider Details

I. General information

NPI: 1770660185
Provider Name (Legal Business Name): JOSEPH LEAL, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 DILWORTH ST
GLENDIVE MT
59330-2053
US

IV. Provider business mailing address

107 DILWORTH ST
GLENDIVE MT
59330-2053
US

V. Phone/Fax

Practice location:
  • Phone: 406-345-8900
  • Fax: 406-345-8908
Mailing address:
  • Phone: 406-345-8900
  • Fax: 406-345-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number6419
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number76
License Number StateMT

VIII. Authorized Official

Name: JOSEPH LEAL
Title or Position: OWNER
Credential: M.D.
Phone: 406-345-8900