Provider Demographics
NPI:1588700660
Name:SMITH, DONNA LYNN (MD)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:LYNN
Last Name:SMITH
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 1:221 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2600
Mailing Address - Country:US
Mailing Address - Phone:406-228-3400
Mailing Address - Fax:406-228-3413
Practice Address - Street 1:221 5TH AVE S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2600
Practice Address - Country:US
Practice Address - Phone:406-228-3400
Practice Address - Fax:406-228-3413
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT35736207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1588700660Medicaid
MTM011005430OtherMEDICARE PTAN
MT976541201OtherBLUE CROS BLUE SHIELD OF MONTANA