Healthcare Provider Details

I. General information

NPI: 1821138272
Provider Name (Legal Business Name): THOMAS LANE SHOWERS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 HIGHWAY 50
GILLETTE WY
82718-9330
US

IV. Provider business mailing address

201 W LAKEWAY RD STE 1004
GILLETTE WY
82718-6349
US

V. Phone/Fax

Practice location:
  • Phone: 307-387-9850
  • Fax: 307-387-9890
Mailing address:
  • Phone: 307-387-9850
  • Fax: 307-387-9890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS005894L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MB06281000
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number17601A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: