Provider Demographics
NPI:1083695928
Name:MCINTYRE, SANDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:S
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:30 HIGHWAY 91 SOUTH
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725
Mailing Address - Country:US
Mailing Address - Phone:406-683-1188
Mailing Address - Fax:406-683-6891
Practice Address - Street 1:30 HIGHWAY 91 SOUTH
Practice Address - Street 2:SUITE 107
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725
Practice Address - Country:US
Practice Address - Phone:406-683-1188
Practice Address - Fax:406-683-6891
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT10859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT10859OtherMONTANA LICENSE
MT0145730Medicaid
I40663Medicare UPIN