Healthcare Provider Details

I. General information

NPI: 1891880647
Provider Name (Legal Business Name): WYOMING ONCOLOGY PROFESSIONALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 01/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 E 2ND ST
CASPER WY
82609-4293
US

IV. Provider business mailing address

6501 E 2ND ST
CASPER WY
82609-4293
US

V. Phone/Fax

Practice location:
  • Phone: 307-235-5433
  • Fax:
Mailing address:
  • Phone: 307-235-5433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4463A
License Number StateWY

VIII. Authorized Official

Name: DR. ROBERT L TOBIN
Title or Position: OWNER
Credential: MD
Phone: 307-235-5433