Basic Information
| Provider Information | |||||||||
| NPI: | 1710052626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELLAND | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | DUNSEITH | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583290100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7016819888 | ||||||||
| FaxNumber: | 7012445801 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 3RD AVE SW | ||||||||
| Address2: | |||||||||
| City: | RUGBY | ||||||||
| State: | ND | ||||||||
| PostalCode: | 583681645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7017765235 | ||||||||
| FaxNumber: | 7017765297 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 05/29/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 6819 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 17848 | 05 | ND | MEDICAID |