Provider Demographics
NPI:1992840128
Name:LAGRECA, BRIAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:A
Last Name:LAGRECA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2475 VILLAGE LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2497
Mailing Address - Country:US
Mailing Address - Phone:406-252-6608
Mailing Address - Fax:406-252-6600
Practice Address - Street 1:2475 VILLAGE LN
Practice Address - Street 2:SUITE 202
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2497
Practice Address - Country:US
Practice Address - Phone:406-252-6608
Practice Address - Fax:406-252-6600
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7090207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0461032OtherMT STATE ID
WY104306400Medicaid
105765101OtherWORKERS COMP - FIC
WY5205AOtherWY MEDICAL LICENSE
MT0048331Medicaid
104306400OtherWORKERS COMP - REG
WY311773OtherWY BCBS
MT7090OtherMT MEDICAL LICENSE
32-0016290OtherFEDERAL TAX ID
99920OtherBCBS PROVIDER NUMBER
MTCJ9407OtherRAILROAD MEDICARE
MT180044575OtherMT RR MEDICARE
BL1975195OtherDEA
WY104306400Medicaid
32-0016290OtherFEDERAL TAX ID
F27010Medicare UPIN
BL1975195OtherDEA