Provider Demographics
NPI:1033205687
Name:DRIVDAHL-SMITH, CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:DRIVDAHL-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 S 7TH ST
Mailing Address - Street 2:SUITE 241
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-3216
Mailing Address - Country:US
Mailing Address - Phone:406-234-1420
Mailing Address - Fax:406-234-1423
Practice Address - Street 1:11 S 7TH ST
Practice Address - Street 2:SUITE 241
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-3216
Practice Address - Country:US
Practice Address - Phone:406-234-1420
Practice Address - Fax:406-234-1423
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8591207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0019720Medicaid
MT8591OtherSTATE LIC NUMBER
MT000099985OtherBCBS PROVIDER NUMBER
MT000084596Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
MT0019720Medicaid