Provider Demographics
NPI:1831126747
Name:GILLESPIE, DONALD NEVIN (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:NEVIN
Last Name:GILLESPIE
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 1:610 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4009
Mailing Address - Country:US
Mailing Address - Phone:406-728-6472
Mailing Address - Fax:406-728-9175
Practice Address - Street 1:610 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4009
Practice Address - Country:US
Practice Address - Phone:406-728-6472
Practice Address - Fax:406-728-9175
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3717207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT034255Medicaid
D90301Medicare UPIN
MT034255Medicaid