Provider Demographics
NPI:1053418582
Name:VARNAVAS, GUS KONSTANTINE GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:GUS
Middle Name:KONSTANTINE GEORGE
Last Name:VARNAVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KONSTANTINE
Other - Middle Name:G
Other - Last Name:VARNAVAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 W PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1931
Mailing Address - Country:US
Mailing Address - Phone:406-563-8500
Mailing Address - Fax:
Practice Address - Street 1:401 W PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-1931
Practice Address - Country:US
Practice Address - Phone:406-563-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8341207T00000X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1053418582Medicaid
MT1053418582OtherNPI
MT8341OtherSTATE LICENSE