Healthcare Provider Details

I. General information

NPI: 1851603146
Provider Name (Legal Business Name): ANDRAS T. EDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2010
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date: 04/16/2020
Reactivation Date: 04/21/2020

III. Provider practice location address

625 E HENNICK ST
PINEDALE WY
82941-5228
US

IV. Provider business mailing address

PO BOX 627
PINEDALE WY
82941-0627
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-4133
  • Fax:
Mailing address:
  • Phone: 307-367-4133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125.076711
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15696A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: