Healthcare Provider Details

I. General information

NPI: 1225023039
Provider Name (Legal Business Name): GREGORY O UTTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMUNITY MEDICAL CENTER PHYSICIAN BUILDING 3 2835 FORT MISSOULA RD. SUITE 304
MISSOULA MT
59804
US

IV. Provider business mailing address

PO BOX 16900
MISSOULA MT
59808-6900
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3924
  • Fax: 406-327-3923
Mailing address:
  • Phone: 406-327-4623
  • Fax: 406-549-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number10965
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: