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NPI Code Detail

MEDICARE: JESTINE TERYSSA MACDONALD MD

MEDICARE: JESTINE TERYSSA MACDONALD MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMED-PHYS-LIC-166222MT

General Provider Information

NPI Number : 1033777503
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESTINE TERYSSA MACDONALD MD
Provider Business Mailing Address
First Line : 401 RAILROAD ST W
Second Line :
City : MISSOULA
State : MT
Zip : 59802-4178
Country : US
Telephone Number : 406-258-4789
Fax Number : 406-258-4732
Provider Business Practice Location Address
First Line : 401 RAILROAD ST W
Second Line :
City : MISSOULA
State : MT
Zip : 59802-4178
Country : US
Telephone Number : 406-258-4789
Fax Number : 406-258-4732
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2019
Last Update Date : 01/21/2026

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