Provider Demographics
NPI:1225023039
Name:UTTER, GREGORY O (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:O
Last Name:UTTER
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 16900
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-6900
Mailing Address - Country:US
Mailing Address - Phone:406-327-4623
Mailing Address - Fax:406-549-5928
Practice Address - Street 1:COMMUNITY MEDICAL CENTER PHYSICIAN BUILDING 3
Practice Address - Street 2:2835 FORT MISSOULA RD. SUITE 304
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804
Practice Address - Country:US
Practice Address - Phone:406-327-3924
Practice Address - Fax:406-327-3923
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10965207VM0101X
MI4301047622207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4301047622OtherCONTROLLED SUBSTANCE
MI2652653Medicaid
BU149517OtherDEA
F01788Medicare UPIN
MI2652653Medicaid