Healthcare Provider Details

I. General information

NPI: 1982159380
Provider Name (Legal Business Name): DURAND BEAR MEDICINE LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2016
Last Update Date: 08/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 POPIMI STREET
BROWNING MT
59417
US

IV. Provider business mailing address

PO BOX 1289
BROWNING MT
59417-1289
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-7912
  • Fax: 406-338-2491
Mailing address:
  • Phone: 406-338-7912
  • Fax: 406-338-2491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-3420
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: