Doctor Name: | DR. GORDON F DUFF GERRISH |
NPI Number: | 1124211297 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 24 |
Business Practice Address: | 56850 Fish Hatchery Road St Ignatius, MT - 59865 |
Business Phone Number: | 4062503282 |
Business Fax Number: | |
Mailing Address: | 56850 Fish Hatchery Road, ST IGNATIUS |
State: | MT |
Postal Code: | 59865 |
Phone Number: | 4062503282 |
Fax Number: | |
NPI Enumeration Date: | 08/22/2007 |
NPI Last Update Date: | 08/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 24 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |