Healthcare Provider Details

I. General information

NPI: 1912996935
Provider Name (Legal Business Name): PETER DAMIAN BARRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 SUNSET BLVD SUITE 4
CONRAD MT
59425
US

IV. Provider business mailing address

805 SUNSET BLVD P O BOX 758
CONRAD MT
59425-0758
US

V. Phone/Fax

Practice location:
  • Phone: 406-271-3231
  • Fax: 406-271-3576
Mailing address:
  • Phone: 406-271-3231
  • Fax: 406-271-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9493
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: