Provider Demographics
NPI:1982159380
Name:BEAR MEDICINE, DURAND (LAC)
Entity Type:Individual
Prefix:MR
First Name:DURAND
Middle Name:
Last Name:BEAR MEDICINE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-1289
Mailing Address - Country:US
Mailing Address - Phone:406-338-7912
Mailing Address - Fax:406-338-2491
Practice Address - Street 1:503 POPIMI STREET
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-7912
Practice Address - Fax:406-338-2491
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LAC-LIC-3420101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1407215684OtherSOUTHERN DIABETES HEALTH CENTER