Healthcare Provider Details

I. General information

NPI: 1033214614
Provider Name (Legal Business Name): DONALD N GILLESPIE MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W SPRUCE ST
MISSOULA MT
59802-4009
US

IV. Provider business mailing address

610 W SPRUCE ST
MISSOULA MT
59802-4009
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-6472
  • Fax: 406-728-9175
Mailing address:
  • Phone: 406-728-6472
  • Fax: 406-728-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number3717
License Number StateMT

VIII. Authorized Official

Name: DR. DONALD N GILLESPIE
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 406-728-6472