Healthcare Provider Details

I. General information

NPI: 1093875494
Provider Name (Legal Business Name): WILLIAM O SARETTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 12/28/2020
Certification Date: 12/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 COLLEGE DR
ROCK SPRINGS WY
82901-5868
US

IV. Provider business mailing address

PO BOX 1359
ROCK SPRINGS WY
82902-1359
US

V. Phone/Fax

Practice location:
  • Phone: 307-362-3711
  • Fax: 307-352-8454
Mailing address:
  • Phone: 307-362-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD2006-0577
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35845
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8429A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: