Provider Demographics
NPI:1528004520
Name:PELCZAR, BRIAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:PELCZAR
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 1:2900 12TH AVE N
Mailing Address - Street 2:SUITE 350W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-238-6161
Mailing Address - Fax:406-238-6171
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 350W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6161
Practice Address - Fax:406-238-6171
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT7342207Y00000X
WYWY5324A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0099047Medicaid
MT0000005861OtherMT BC/BS
MT0099047Medicaid