Provider Demographics
NPI:1871537878
Name:MCCALL, GWENDOLYN G (MD)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:G
Last Name:MCCALL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 HIGHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6902
Mailing Address - Country:US
Mailing Address - Phone:406-414-5000
Mailing Address - Fax:
Practice Address - Street 1:206 ALASKA FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-7909
Practice Address - Country:US
Practice Address - Phone:406-414-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-49990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1871537878Medicaid
GA000788466JMedicaid
GA10065025OtherAMERIGROUP
GAP00267562OtherRAILROAD MEDICARE
GA000788466IMedicaid
G71542Medicare UPIN
GA000788466IMedicaid
GA202I089031Medicare PIN