Healthcare Provider Details

I. General information

NPI: 1093998098
Provider Name (Legal Business Name): THOMAS E SPICER, MD-PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 HILLTOP DR SUITE 103
ROCK SPRINGS WY
82901-5857
US

IV. Provider business mailing address

1208 HILLTOP DR SUITE 103
ROCK SPRINGS WY
82901-5857
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number2513A
License Number StateWY

VIII. Authorized Official

Name: CHERYL A PADILLA
Title or Position: OFFICE MANAGER
Credential:
Phone: 307-362-8211