Individual
DR. JON R GILDEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2946 STARLIGHT DRIVE, MISSOULA, MT 59803
(406) 240-2148
Mailing address
DEPT CH 17767, PALATINE, IL 60055-0001
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
5101014660
MI
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
10620
MT
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
5101014660
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4614956
—
MI
05
—
4615292
—
MI
05
—
4617359
—
MI
01
—
JG014660
BLUE CROSS BLUE SHIELD
—
01
—
P00158334
RAILROAD MEDICARE
—
Enumeration date
11/23/2005
Last updated
03/08/2021
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