Healthcare Provider Details

I. General information

NPI: 1417952391
Provider Name (Legal Business Name): GARY NOE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N MAIN ST.
LYMAN WY
82937
US

IV. Provider business mailing address

PO BOX 189
LYMAN WY
82937-0189
US

V. Phone/Fax

Practice location:
  • Phone: 307-787-3313
  • Fax: 307-787-3312
Mailing address:
  • Phone: 307-787-3313
  • Fax: 307-787-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3898A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: