Provider Demographics
NPI:1114074903
Name:GERRIE, ROBERT DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DUANE
Last Name:GERRIE
Suffix:
Gender:M
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:PO BOX 208
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-0208
Mailing Address - Country:US
Mailing Address - Phone:406-883-1307
Mailing Address - Fax:406-883-0741
Practice Address - Street 1:# 6 THIRTEENTH AVE. E.
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59864
Practice Address - Country:US
Practice Address - Phone:406-883-8479
Practice Address - Fax:406-883-8415
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10029208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1122725Medicare ID - Type Unspecified
MTC32022Medicare UPIN