Individual
BRETT ALLEN BASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1210 W 18TH ST, STE 104, SIOUX FALLS, SD 57104-4647
(605) 328-8660
(605) 328-8661
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0439
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6821692
—
SD
Enumeration date
07/12/2006
Last updated
01/30/2009
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