Healthcare Provider Details

I. General information

NPI: 1033342563
Provider Name (Legal Business Name): THOMAS E. SPICER, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 HILLTOP DR STE 103
ROCK SPRINGS WY
82901-5858
US

IV. Provider business mailing address

1208 HILLTOP DR STE 103
ROCK SPRINGS WY
82901-5858
US

V. Phone/Fax

Practice location:
  • Phone: 307-362-8211
  • Fax: 307-382-3451
Mailing address:
  • Phone: 307-362-8211
  • Fax: 307-382-3451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2513A
License Number StateWY

VIII. Authorized Official

Name: DR. THOMAS E SPICER
Title or Position: OWNER
Credential: MD
Phone: 307-362-8211