Healthcare Provider Details

I. General information

NPI: 1699723395
Provider Name (Legal Business Name): WIND RIVER EAR, NOSE & THROAT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8185 HIGHWAY 789
LANDER WY
82520-2942
US

IV. Provider business mailing address

8185 HIGHWAY 789
LANDER WY
82520-2942
US

V. Phone/Fax

Practice location:
  • Phone: 307-335-7555
  • Fax: 307-335-7999
Mailing address:
  • Phone: 307-335-7555
  • Fax: 307-335-7999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT L FISCHER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 307-335-7555