Provider Demographics
NPI:1982686804
Name:PYETTE, ROYCE G (MD)
Entity Type:Individual
Prefix:
First Name:ROYCE
Middle Name:G
Last Name:PYETTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 ELLIS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8812
Mailing Address - Country:US
Mailing Address - Phone:406-587-0122
Mailing Address - Fax:406-587-5548
Practice Address - Street 1:1450 ELLIS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8812
Practice Address - Country:US
Practice Address - Phone:406-587-0122
Practice Address - Fax:406-587-5548
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT8251207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT53313Medicaid
MT000082895Medicare ID - Type Unspecified
MT53313Medicaid