Healthcare Provider Details

I. General information

NPI: 1831261189
Provider Name (Legal Business Name): KARY L AYTES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N ORANGE ST SUITE 304
MISSOULA MT
59802-2998
US

IV. Provider business mailing address

900 N ORANGE ST SUITE 304
MISSOULA MT
59802-2998
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3362
  • Fax: 406-327-3346
Mailing address:
  • Phone: 406-327-3362
  • Fax: 406-327-3346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMED-PHYS-LIC-7789
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number7789
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: