Healthcare Provider Details

I. General information

NPI: 1760452791
Provider Name (Legal Business Name): BRIAN ARTHUR MOLLOY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 SOUTH 7650 EAST
CROW AGENCY MT
59022-0009
US

IV. Provider business mailing address

2130 POLY DR
BILLINGS MT
59102-1625
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3500
  • Fax: 406-638-3535
Mailing address:
  • Phone: 406-855-7000
  • Fax: 406-638-3535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number606769
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number606769
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: