Individual
BRANDON JAIME EGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
500 W BROADWAY ST STE 320, MISSOULA, MT 59802-4003
(406) 329-5615
(406) 329-2791
Mailing address
500 W BROADWAY ST STE 320, MISSOULA, MT 59802-4003
(406) 329-5615
(406) 329-2791
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
66952
MT
363AM0700X
Medical Physician Assistant
MA056269
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LICENSE
MA056269
PA
Enumeration date
08/01/2013
Last updated
05/18/2021
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