Provider Demographics
NPI:1821083452
Name:SACRY, GAYLE FAYE (MD)
Entity Type:Individual
Prefix:
First Name:GAYLE
Middle Name:FAYE
Last Name:SACRY
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:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MT
Mailing Address - Zip Code:59759-0339
Mailing Address - Country:US
Mailing Address - Phone:406-287-3003
Mailing Address - Fax:406-287-3014
Practice Address - Street 1:108 W FIRST ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MT
Practice Address - Zip Code:59759-0339
Practice Address - Country:US
Practice Address - Phone:406-287-3003
Practice Address - Fax:406-287-3014
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
184739200OtherFED WORK COMP GROUP ID
WA138829OtherWA WORK COMP
ID0005622Medicaid
MT0068744Medicaid
MT07160OtherBCBS MT PROV ID
MT3623OtherMT LICENSE
MT3623OtherMT LICENSE
ID0005622Medicaid
184739200OtherFED WORK COMP GROUP ID
AS1129685OtherDEA
A11427Medicare UPIN
022079000Medicare NSC