Healthcare Provider Details

I. General information

NPI: 1346476181
Provider Name (Legal Business Name): BRANDON J. NEWGARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2009
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2475 E BROADWAY ST
HELENA MT
59601-4928
US

IV. Provider business mailing address

PO BOX 6369
HELENA MT
59604-6369
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-4180
  • Fax:
Mailing address:
  • Phone: 406-447-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number39905
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number39905
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: