Healthcare Provider Details

I. General information

NPI: 1710931225
Provider Name (Legal Business Name): MISSOULA ANESTHESIOLOGY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 STOCKYARD RD
MISSOULA MT
59808-1503
US

IV. Provider business mailing address

PO BOX 94484
SEATTLE WA
98124-6784
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-8420
  • Fax: 406-541-8430
Mailing address:
  • Phone: 406-728-8420
  • Fax: 406-541-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BARBARA P GILLETT-BRETZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 406-728-8420