Individual
BRIAN M. SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2702 8TH AVE N, BILLINGS, MT 59101-1107
(406) 238-2500
Mailing address
PO BOX 35100, BILLINGS, MT 59107-5100
(406) 238-2500
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
209
MT
363AS0400X
Surgical Physician Assistant
Primary
MED-PAC-LIC-209
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000092473
BCBS PIN
MT
01
—
0434146
MDCD PIN
MT
01
—
122978800
MDCD PIN
WY
Enumeration date
11/04/2006
Last updated
12/14/2021
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