Basic Information
| Provider Information | |||||||||
| NPI: | 1396123659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEAR-RUEL | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3031 | ||||||||
| Address2: | |||||||||
| City: | KALISPELL | ||||||||
| State: | MT | ||||||||
| PostalCode: | 599033031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067523239 | ||||||||
| FaxNumber: | 4067523252 | ||||||||
| Practice Location | |||||||||
| Address1: | 1675 TALBOT ROAD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA FALLS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068923208 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2015 | ||||||||
| LastUpdateDate: | 11/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 68157 | MT | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.