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General NPI Number Information
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NPI Number | 1770724874
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Entity Type | Organization
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Legal Business Name | DR. BEVERLY L. BRAAK, P.C.
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Dates
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Enumeration Date | 03/19/2009
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 2831 FORT MISSOULA RD BLDG 2 SUITE 203
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City | MISSOULA
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State | MT
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Zip | 59804-7419
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Country | US
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Telephone | 406-327-3875
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Fax | 406-327-3876
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Provider Business Mailing Address
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Address Line | 2831 FORT MISSOULA RD BLDG 2 SUITE 203
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City | MISSOULA
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State | MT
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Zip | 59804-7419
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Country | US
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Telephone | 406-327-3875
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Fax | 406-327-3876
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Authorized Official
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Title or Position | OWNER
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Name | DR. BEVERLY LYNN BRAAK
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Credential | M.D.
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Telephone | 406-327-3875
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 11310
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License Number State | MT
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