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NPI Code Detail

MEDICARE: GORDON D. STILLIE D.O.

MEDICARE: GORDON D. STILLIE D.O.
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
12085R0001XRadiation Oncology Physician10467MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
199676OTHERMTBLUE CROSS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316993082
Entity Type Code : Individual
Provider Name (Legal Business Name) : GORDON D. STILLIE D.O.
Provider Business Mailing Address
First Line : PO BOX 7653
Second Line :
City : KALISPELL
State : MT
Zip : 59904-0653
Country : US
Telephone Number : 406-751-6948
Fax Number :
Provider Business Practice Location Address
First Line : 343 SUNNYVIEW LN
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3156
Country : US
Telephone Number : 406-752-1790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/25/2006
Last Update Date : 07/08/2007

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