MEDICARE: GAYLE FAYE SACRY M.D.

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
1	207Q00000X	Family Medicine Physician	3623	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	184739200	OTHER		FED WORK COMP GROUP ID
2	138829	OTHER	WA	WA WORK COMP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	07160	OTHER	MT	BCBS MT PROV ID
6	3623	OTHER	MT	MT LICENSE

General Provider Information

NPI Number	:	1821083452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAYLE FAYE SACRY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 339
Second Line	:
City	:	WHITEHALL
State	:	MT
Zip	:	59759-0339
Country	:	US
Telephone Number	:	406-287-3003
Fax Number	:	406-287-3014

Provider Business Practice Location Address
First Line	:	108 W FIRST ST
Second Line	:
City	:	WHITEHALL
State	:	MT
Zip	:	59759-0339
Country	:	US
Telephone Number	:	406-287-3003
Fax Number	:	406-287-3014

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	03/07/2023

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