Provider Demographics
NPI:1275735748
Name:MOURNIAN, GERALDINE BERNICE (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:BERNICE
Last Name:MOURNIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 1274B
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-9725
Mailing Address - Country:US
Mailing Address - Phone:503-754-1204
Mailing Address - Fax:
Practice Address - Street 1:10110 S 7650 E
Practice Address - Street 2:PHS INDIAN HOSPITAL
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3300
Practice Address - Fax:406-638-3572
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12153207Q00000X
ORMD27510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine