Healthcare Provider Details

I. General information

NPI: 1487782322
Provider Name (Legal Business Name): BRETT R BENNION, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 14TH AVE SW STE 101
SIDNEY MT
59270-3521
US

IV. Provider business mailing address

214 14TH AVE SW STE 101
SIDNEY MT
59270-3521
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-2380
  • Fax: 406-488-2382
Mailing address:
  • Phone: 406-488-2380
  • Fax: 406-488-2382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8624
License Number StateMT

VIII. Authorized Official

Name: BRETT BENNION
Title or Position: OWNER
Credential: MD
Phone: 406-488-2380