Provider Demographics
NPI:1205162922
Name:NASH, MARC BRYAN (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:BRYAN
Last Name:NASH
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 1:400 S CLARK ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2328
Mailing Address - Country:US
Mailing Address - Phone:406-723-2621
Mailing Address - Fax:406-723-2470
Practice Address - Street 1:400 S CLARK ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2328
Practice Address - Country:US
Practice Address - Phone:406-723-2621
Practice Address - Fax:406-723-2470
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1005072085R0001X
MT206212085R0001X
IA405892085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011002887Medicare PIN