Healthcare Provider Details

I. General information

NPI: 1447362645
Provider Name (Legal Business Name): GILBERT EARL LEPEL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BERT EARL LEPEL PA-C

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 14TH AVE SW
SIDNEY MT
59270-3521
US

IV. Provider business mailing address

216 14TH AVE SW
SIDNEY MT
59270-3519
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-2100
  • Fax: 406-488-2125
Mailing address:
  • Phone: 406-488-2100
  • Fax: 406-433-2125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0349
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number49
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: