Healthcare Provider Details

I. General information

NPI: 1891058558
Provider Name (Legal Business Name): PHILIP MICHAEL ESKEW DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7076 ROAD 55F
TORRINGTON WY
82240-7771
US

IV. Provider business mailing address

7076 ROAD 55F
TORRINGTON WY
82240-7771
US

V. Phone/Fax

Practice location:
  • Phone: 307-532-6673
  • Fax: 307-532-6676
Mailing address:
  • Phone: 307-532-6673
  • Fax: 307-532-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0116024836
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS016968
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10037A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: