Individual
BRIAN G WILLOUGHBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 HIGHWAY 12, HETTINGER, ND 58639
(701) 567-4561
Mailing address
1100 HIGHWAY 12, HETTINGER, ND 58639-7533
(701) 567-6130
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5103
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0568253
—
IA
01
—
10781
ND BLUE CROSS/BLUE SHIELD
—
01
—
123993
WORKER'S COMP
ND
05
—
14656
—
ND
01
—
25451
SIOUX VALLEY
—
05
—
3018140
—
WA
05
—
45034068812
—
NE
05
—
7088230-00
—
MN
05
—
7776070
—
SD
Enumeration date
10/03/2006
Last updated
02/03/2014
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