MEDICARE: ERIC BRANDEBERRY M.D.

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	207Q00000X	Family Medicine Physician	10481	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1992747836	OTHER	MT	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992747836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC BRANDEBERRY M.D.

Provider Business Mailing Address
First Line	:	1287 BURNS WAY
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-3109
Country	:	US
Telephone Number	:	406-752-8120
Fax Number	:	406-752-8134

Provider Business Practice Location Address
First Line	:	1850 9TH ST W
Second Line	:
City	:	COLUMBIA FALLS
State	:	MT
Zip	:	59912-4410
Country	:	US
Telephone Number	:	406-892-3206
Fax Number	:	406-892-2381

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	11/27/2023

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