Healthcare Provider Details

I. General information

NPI: 1801982947
Provider Name (Legal Business Name): JAMES J NARAMORE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S MEDICAL ARTS COURT SUITE E
GILLETTE WY
82716-3372
US

IV. Provider business mailing address

407 S MEDICAL ARTS COURT SUITE E
GILLETTE WY
82716-3372
US

V. Phone/Fax

Practice location:
  • Phone: 307-682-1234
  • Fax: 307-686-6167
Mailing address:
  • Phone: 307-682-1234
  • Fax: 307-686-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number53D0520056
License Number StateWY

VIII. Authorized Official

Name: RONALD WOLF
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 307-670-0740