Healthcare Provider Details

I. General information

NPI: 1295762714
Provider Name (Legal Business Name): JAMIE GOGAL STRAUB D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 13TH AVE E ST. JOSEPH MEDICAL CENTER
POLSON MT
59860-5315
US

IV. Provider business mailing address

41276 FLATHEAD VIEW DR
POLSON MT
59860-7492
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-5680
  • Fax: 406-883-8910
Mailing address:
  • Phone: 406-883-1315
  • Fax: 406-883-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number12406
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: