Provider Demographics
NPI:1699757682
Name:BROST, DAVID P (PAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:P
Last Name:BROST
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 29TH ST S # SCI
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5306
Mailing Address - Country:US
Mailing Address - Phone:406-455-5000
Mailing Address - Fax:406-731-8318
Practice Address - Street 1:1117 29TH ST S # SCI
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5306
Practice Address - Country:US
Practice Address - Phone:406-731-8888
Practice Address - Fax:406-731-8318
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT348363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP00077067OtherRAILROAD MEDICARE
MT4301856OtherBLUE CROSS
MT4301856Medicaid
WYP00367450OtherRAILROAD MEDICARE
MT810511516025OtherEBMS
MT810511516025OtherEBMS
MTP00077067OtherRAILROAD MEDICARE
MT4301856Medicaid