Provider Demographics
NPI:1801993860
Name:BERTHA, BRIAN G (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:BERTHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:401 15TH AVE S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-727-6311
Mailing Address - Fax:406-727-1070
Practice Address - Street 1:1101 26TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5161
Practice Address - Country:US
Practice Address - Phone:406-731-8888
Practice Address - Fax:406-731-8138
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MT6868207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT68867Medicaid
MT68867Medicaid
83189Medicare ID - Type Unspecified