Provider Demographics
NPI:1275541559
Name:DONALD H BERDEAUX MD FACP PC
Entity Type:Organization
Organization Name:DONALD H BERDEAUX MD FACP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BERDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-731-8150
Mailing Address - Street 1:1117 29TH ST S STE 400
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5309
Mailing Address - Country:US
Mailing Address - Phone:406-731-8150
Mailing Address - Fax:406-731-8178
Practice Address - Street 1:1117 29TH ST S STE 400
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5309
Practice Address - Country:US
Practice Address - Phone:406-731-8150
Practice Address - Fax:406-731-8178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7270207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTCH7766OtherRAILROAD MC GROUP NUMBER
MTCH7766OtherRAILROAD MC GROUP NUMBER