Healthcare Provider Details

I. General information

NPI: 1497055891
Provider Name (Legal Business Name): RAMZI T AMMARI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W 4TH STREET
GILLETTE WY
82716-3339
US

IV. Provider business mailing address

1300 W 4TH STREET
GILLETTE WY
82716-3339
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-7031
  • Fax: 307-686-3619
Mailing address:
  • Phone: 307-686-7031
  • Fax: 307-686-3619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5967A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number5967A
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number5967A
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number5967A
License Number StateWY

VIII. Authorized Official

Name: RADONA K BORGIALLI
Title or Position: OFFICE MANAGER
Credential:
Phone: 307-686-7031