Provider Demographics
NPI:1962457663
Name:HARVEY, GARY PHILLIP (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:PHILLIP
Last Name:HARVEY
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 1:2835 FORT MISSOULA RD
Mailing Address - Street 2:STE 202
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7424
Mailing Address - Country:US
Mailing Address - Phone:406-728-4292
Mailing Address - Fax:406-728-5770
Practice Address - Street 1:2825 FORT MISSOULA RD
Practice Address - Street 2:115
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804
Practice Address - Country:US
Practice Address - Phone:406-728-4292
Practice Address - Fax:406-728-5770
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7259207V00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000097686OtherBLUE CROSS BLUE SHIELD OF
MT0097942Medicaid
MT0177840Medicaid
011000550Medicare PIN
MT0097942Medicaid
MT0177840Medicaid