MEDICARE: BRYNN MARIE BIXBY MPAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	608	MT

General Provider Information

NPI Number	:	1760707186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYNN MARIE BIXBY MPAC

Provider Business Mailing Address
First Line	:	1207 2ND ST W
Second Line	:
City	:	ROUNDUP
State	:	MT
Zip	:	59072-1835
Country	:	US
Telephone Number	:	406-323-3337
Fax Number	:

Provider Business Practice Location Address
First Line	:	1207 2ND ST W
Second Line	:
City	:	ROUNDUP
State	:	MT
Zip	:	59072-1835
Country	:	US
Telephone Number	:	406-323-3337
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	03/29/2010

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Directions to “ BRYNN MARIE BIXBY MPAC” Practice Location

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