1992840128 NPI number — DR. BRIAN A LAGRECA M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992840128 NPI number — DR. BRIAN A LAGRECA M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LAGRECA

Provider First Name:

BRIAN

Provider Middle Name:

A

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1992840128

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/07/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2475 VILLAGE LN

Provider Second Line Business Mailing Address:

SUITE 202

Provider Business Mailing Address City Name:

BILLINGS

Provider Business Mailing Address State Name:

MT

Provider Business Mailing Address Postal Code:

59102-2497

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

406-252-6608

Provider Business Mailing Address Fax Number:

406-252-6600

Provider First Line Business Practice Location Address:

2475 VILLAGE LN

Provider Second Line Business Practice Location Address:

SUITE 202

Provider Business Practice Location Address City Name:

BILLINGS

Provider Business Practice Location Address State Name:

MT

Provider Business Practice Location Address Postal Code:

59102-2497

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

406-252-6608

Provider Business Practice Location Address Fax Number:

406-252-6600

Provider Enumeration Date:

02/21/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207W00000X , with the licence number:  7090 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0461032 . This is a "MT STATE ID" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
• Identifier: 104306400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
• Identifier: 105765101 . This is a "WORKERS COMP - FIC" identifier . This identifiers is of the category "OTHER".
• Identifier: 5205A . This is a "WY MEDICAL LICENSE" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
• Identifier: 0048331 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 104306400 . This is a "WORKERS COMP - REG" identifier . This identifiers is of the category "OTHER".
• Identifier: 311773 . This is a "WY BCBS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
• Identifier: 7090 . This is a "MT MEDICAL LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
• Identifier: 32-0016290 . This is a "FEDERAL TAX ID" identifier . This identifiers is of the category "OTHER".
• Identifier: 99920 . This is a "BCBS PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
• Identifier: CJ9407 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
• Identifier: 180044575 . This is a "MT RR MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".