Individual
DR. BRADY J BANTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2600 WILSON ST, MILES CITY, MT 59301-5094
(406) 233-2600
Mailing address
PO BOX 580, MILES CITY, MT 59301-0580
(406) 853-3018
(406) 234-1644
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
10819
MT
2085N0700X
Neuroradiology Physician
10819
MT
2085N0904X
Nuclear Radiology Physician
10819
MT
2085P0229X
Pediatric Radiology Physician
10819
MT
2085R0202X
Diagnostic Radiology Physician
Primary
10819
MT
2085R0202X
Diagnostic Radiology Physician
C151246
CA
2085R0204X
Vascular & Interventional Radiology Physician
10819
MT
2085U0001X
Diagnostic Ultrasound Physician
10819
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000094556
BLUE CROSS
MT
05
—
0157488
—
MT
Enumeration date
05/10/2006
Last updated
11/27/2024
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