Provider Demographics
NPI:1780714071
Name:PHINNEY, DEANNA (MD)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:PHINNEY
Suffix:
Gender:F
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 N CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3950
Mailing Address - Country:US
Mailing Address - Phone:406-721-1646
Mailing Address - Fax:406-543-9890
Practice Address - Street 1:610 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-721-1646
Practice Address - Fax:406-543-9890
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8204174400000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0152503Medicaid
MT000093056OtherBCBS
MT0152503Medicaid
MT000093056OtherBCBS