Healthcare Provider Details

I. General information

NPI: 1275616104
Provider Name (Legal Business Name): BRETT RUSSELL BENNION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 14TH AVE SW SUITE 101
SIDNEY MT
59270
US

IV. Provider business mailing address

214 14TH AVE SW SUITE 101
SIDNEY MT
59270
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 Code207Y00000X
TaxonomyOtolaryngology Physician
License Number8624
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: