Healthcare Provider Details

I. General information

NPI: 1518983212
Provider Name (Legal Business Name): ALAN DOYLE REYES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 12/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 REGENT ST STE 103
MISSOULA MT
59801-7927
US

IV. Provider business mailing address

25 S FRONTAGE RD W
ALBERTON MT
59820-9406
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-2202
  • Fax: 406-728-2620
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number9784
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: