Provider Demographics
NPI:1598838484
Name:GULDE, BRYANT LEE (CPO)
Entity Type:Individual
Prefix:MR
First Name:BRYANT
Middle Name:LEE
Last Name:GULDE
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 N 27TH ST STE C2
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0107
Mailing Address - Country:US
Mailing Address - Phone:406-252-6100
Mailing Address - Fax:406-252-4276
Practice Address - Street 1:1020 S 24TH ST W
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6406
Practice Address - Country:US
Practice Address - Phone:406-655-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT310720OtherBLUE CROSS BLUE SHIELD
MT5601874Medicaid