Provider Demographics
NPI:1831140532
Name:KOMM, BRIAN D (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:KOMM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 OTTAWA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6539
Mailing Address - Country:US
Mailing Address - Phone:406-723-7990
Mailing Address - Fax:406-723-0080
Practice Address - Street 1:3215 OTTAWA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6539
Practice Address - Country:US
Practice Address - Phone:406-723-7990
Practice Address - Fax:406-723-0080
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT147213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000390558Medicaid
MT1417132820OtherGROUP NPI
MT018841OtherBCBS
MT00082455Medicare PIN
MT0000390558Medicaid
MT00082456Medicare PIN
MT018841OtherBCBS