MEDICARE: PROFESSIONAL PATHOLOGY OF WYOMING

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1922953405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL PATHOLOGY OF WYOMING

Provider Business Mailing Address
First Line	:	PO BOX 421565
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77242-1565
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 SOUTH JEFFERSON STREET
Second Line	:
City	:	CASPER
State	:	WY
Zip	:	82601
Country	:	US
Telephone Number	:	877-697-2447
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	HOWARD MARTIN III
Credential	:	MD
Telephone Number	:	877-697-2447

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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