Provider Demographics
NPI:1770673998
Name:HENNEFORD, GORDON EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:EUGENE
Last Name:HENNEFORD
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 1:2756 GREGORY DR S
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0510
Mailing Address - Country:US
Mailing Address - Phone:406-656-3663
Mailing Address - Fax:
Practice Address - Street 1:2345 KING AVE W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6422
Practice Address - Country:US
Practice Address - Phone:406-651-5670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist