Provider Demographics
NPI:1609965946
Name:SPENCER, GERALD D (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:D
Last Name:SPENCER
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 1:1300 28TH ST S
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405
Mailing Address - Country:US
Mailing Address - Phone:406-455-5870
Mailing Address - Fax:406-731-8079
Practice Address - Street 1:1300 28TH ST S
Practice Address - Street 2:SUITE 3
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405
Practice Address - Country:US
Practice Address - Phone:406-455-5870
Practice Address - Fax:406-731-8079
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5199207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT48994Medicaid
100016422OtherRAILROAD MEDICARE
MT099930OtherBLUE CROSS
MT82643Medicare ID - Type Unspecified
MT099930OtherBLUE CROSS
100016422OtherRAILROAD MEDICARE