Provider Demographics
NPI:1699765602
Name:BIRNEL, DEANN LAREE (MD)
Entity type:Individual
Prefix:
First Name:DEANN
Middle Name:LAREE
Last Name:BIRNEL
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 1:835 SPEEDWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-5563
Mailing Address - Country:US
Mailing Address - Phone:406-549-8011
Mailing Address - Fax:
Practice Address - Street 1:835 SPEEDWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-5563
Practice Address - Country:US
Practice Address - Phone:406-549-8011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10149207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806816200Medicaid
MT0070669Medicaid
MT0070669Medicaid