Provider Demographics
NPI:1063510352
Name:REMILLARD, DEBRA J (PAC)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:J
Last Name:REMILLARD
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SOUTH LAST CHANCE GULCH
Mailing Address - Street 2:STE 3
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4134
Mailing Address - Country:US
Mailing Address - Phone:406-442-3534
Mailing Address - Fax:406-442-2064
Practice Address - Street 1:50 SOUTH LAST CHANCE GULCH
Practice Address - Street 2:STE 3
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4134
Practice Address - Country:US
Practice Address - Phone:406-442-3534
Practice Address - Fax:406-442-2064
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT127207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0434809Medicaid
970010030OtherRAILROAD MEDICARE
000080330Medicare ID - Type Unspecified
S32543Medicare UPIN
MT000081216Medicare PIN