Healthcare Provider Details

I. General information

NPI: 1235561507
Provider Name (Legal Business Name): JAMES ROBERT ALLEN BEDIENT BEDIENT MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2802 W C ST
TORRINGTON WY
82240-1834
US

IV. Provider business mailing address

802 E 18TH AVE
TORRINGTON WY
82240-3029
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-0134
  • Fax:
Mailing address:
  • Phone: 307-401-0598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPPC-1303
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: