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1104813930

NPI Code Detail

MEDICARE: DR. THOMAS OTTO MAYER MD

MEDICARE: DR. THOMAS OTTO MAYER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	6950A	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05696001	OTHER	WY	BCBS CLINIC NUMBER
2	313252	OTHER	WY	BCBS INDIVIDUAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	148019300	OTHER		FEDERAL WORKERS COMPENSAT
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104813930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS OTTO MAYER MD

Provider Business Mailing Address
First Line	:	1050 MYDLAND RD
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-2186
Country	:	US
Telephone Number	:	307-673-6300
Fax Number	:	307-673-6303

Provider Business Practice Location Address
First Line	:	1050 MYDLAND RD
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-2186
Country	:	US
Telephone Number	:	307-673-6300
Fax Number	:	307-673-6303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/09/2007

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Directions to “ DR. THOMAS OTTO MAYER MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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