Healthcare Provider Details

I. General information

NPI: 1831126747
Provider Name (Legal Business Name): DONALD NEVIN GILLESPIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
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 Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number3717
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: