Healthcare Provider Details

I. General information

NPI: 1124123815
Provider Name (Legal Business Name): FREMONT ORTHOPAEDIC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 E MAIN ST
LANDER WY
82520-3491
US

IV. Provider business mailing address

815 E MAIN ST
LANDER WY
82520-3491
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-9720
  • Fax: 307-332-8206
Mailing address:
  • Phone: 307-332-9720
  • Fax: 307-332-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number0550060001
License Number StateWY

VIII. Authorized Official

Name: JOHN A WHIPP
Title or Position: OWNER
Credential: M.D.
Phone: 307-332-9720