Basic Information
| Provider Information | |||||||||
| NPI: | 1023134293 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ABBOTT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3150 N MONTANA AVE | ||||||||
| Address2: | STE A | ||||||||
| City: | HELENA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 596027804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072126522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3150 N MONTANA AVE STE A | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064225817 | ||||||||
| FaxNumber: | 4064225928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 09/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QS0010X | 77129 | MT | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1619166972 | 05 | MT | MEDICAID |