| Doctor Name: | DR. BRADY J BANTA |
| NPI Number: | 1710937156 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 10819 |
| Business Practice Address: | 2600 Wilson St Miles City, MT - 593015094 |
| Business Phone Number: | 4062332600 |
| Business Fax Number: | |
| Mailing Address: | Po Box 580, MILES CITY |
| State: | MT |
| Postal Code: | 593010580 |
| Phone Number: | 4068533018 |
| Fax Number: | 4062341644 |
| NPI Enumeration Date: | 05/10/2006 |
| NPI Last Update Date: | 03/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 10819 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MT |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |