Provider Demographics
NPI:1265465207
Name:GILLIS, SHAUN J (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUN
Middle Name:J
Last Name:GILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 HIGHLAND BLVD
Mailing Address - Street 2:STE 4440
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6901
Mailing Address - Country:US
Mailing Address - Phone:406-556-5150
Mailing Address - Fax:406-556-5155
Practice Address - Street 1:905 HIGHLAND BLVD STE 4500
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6903
Practice Address - Country:US
Practice Address - Phone:406-414-5150
Practice Address - Fax:406-414-5175
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10375207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000099115OtherBCBS
MT0063580Medicaid
000099115OtherBCBS
MT0063580Medicaid
MT000084436Medicare ID - Type UnspecifiedINDIVIDUAL PROV #