Provider Demographics
NPI:1396123659
Name:DEAR-RUEL, AMY MARIE (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MARIE
Last Name:DEAR-RUEL
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:PO BOX 3031
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-3031
Mailing Address - Country:US
Mailing Address - Phone:406-752-3239
Mailing Address - Fax:406-752-3252
Practice Address - Street 1:1675 TALBOT ROAD
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912
Practice Address - Country:US
Practice Address - Phone:406-892-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT68157207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program