=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417132820
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRIAN KOMM DPM PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2008
-----------------------------------------------------
Last Update Date | 02/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3215 OTTAWA ST
-----------------------------------------------------
City | BUTTE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59701-6539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-723-7990
-----------------------------------------------------
Fax | 406-723-0080
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3215 OTTAWA ST
-----------------------------------------------------
City | BUTTE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59701-6539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-723-7990
-----------------------------------------------------
Fax | 406-723-0080
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. BRIAN D KOMM
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 406-723-7990
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213EP1101X
-----------------------------------------------------
Taxonomy Name | Primary Podiatric Medicine Podiatrist
-----------------------------------------------------
License Number | 147
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------