Healthcare Provider Details

I. General information

NPI: 1124182100
Provider Name (Legal Business Name): BERTON JAMES TOEWS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4911 E 16TH ST
CASPER WY
82609-3764
US

IV. Provider business mailing address

4911 E 16TH ST
CASPER WY
82609-3764
US

V. Phone/Fax

Practice location:
  • Phone: 307-259-4884
  • Fax: 307-242-5050
Mailing address:
  • Phone: 307-259-4884
  • Fax: 307-242-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberA2627A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: