Provider Demographics
NPI:1275616104
Name:BENNION, BRETT RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:RUSSELL
Last Name:BENNION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 14TH AVE SW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270
Mailing Address - Country:US
Mailing Address - Phone:406-488-2380
Mailing Address - Fax:406-488-2382
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:SUITE 101
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270
Practice Address - Country:US
Practice Address - Phone:406-488-2380
Practice Address - Fax:406-488-2382
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8624207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040014113OtherRAILROAD MEDICARE
MT0015759Medicaid
ND10976Medicaid
MT000018941OtherBLUE CROSS
ND18595OtherBLUE CROSS
ND18595OtherBLUE CROSS
ND20253Medicare ID - Type Unspecified
MT000018941OtherBLUE CROSS