Provider Demographics
NPI:1235409988
Name:HILL, WAYNE ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:ALLEN
Last Name:HILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:ALLEN
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-0707
Mailing Address - Country:US
Mailing Address - Phone:406-446-2924
Mailing Address - Fax:
Practice Address - Street 1:397 HIGHWAY 78
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068
Practice Address - Country:US
Practice Address - Phone:406-446-2924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT101172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTD-25956Medicare UPIN