Provider Demographics
NPI:1770716201
Name:FALK, GAVIN ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:ALEXANDER
Last Name:FALK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1333 SURGICAL SERVICES DRIVE
Mailing Address - Street 2:NORTHWEST MONTANA SURGICAL ASSOCIATES
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-5000
Mailing Address - Fax:406-752-8220
Practice Address - Street 1:1333 SURGICAL SERVICES DRIVE
Practice Address - Street 2:NORTHWEST MONTANA SURGICAL ASSOCIATES
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-5000
Practice Address - Fax:406-752-8220
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT444272086S0120X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program