Healthcare Provider Details

I. General information

NPI: 1902889280
Provider Name (Legal Business Name): ALEXANDER G. CIANFLONE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ALEXANDER GREGORY CIANFLONE MD

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 AVENUE H
POWELL WY
82435-2260
US

IV. Provider business mailing address

PO BOX 2570
CODY WY
82414-2570
US

V. Phone/Fax

Practice location:
  • Phone: 307-754-1107
  • Fax:
Mailing address:
  • Phone: 719-369-3357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5280A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: