Healthcare Provider Details

I. General information

NPI: 1104883461
Provider Name (Legal Business Name): THUNDER BASIN ORTHOPAEDICS AND SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 5TH ST
DOUGLAS WY
82633-2434
US

IV. Provider business mailing address

PO BOX 688
DOUGLAS WY
82633-0688
US

V. Phone/Fax

Practice location:
  • Phone: 307-358-6200
  • Fax: 307-358-3748
Mailing address:
  • Phone: 307-358-6200
  • Fax: 307-358-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK G MURPHY
Title or Position: PRESIDENT
Credential: MD
Phone: 307-358-6200