Healthcare Provider Details

I. General information

NPI: 1790764520
Provider Name (Legal Business Name): BRETT J ARGERIS PAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SOUTH 15TH STREET
WORLAND WY
82401
US

IV. Provider business mailing address

400 SOUTH 15TH STREET
WORLAND WY
82401
US

V. Phone/Fax

Practice location:
  • Phone: 307-347-5810
  • Fax: 307-347-5808
Mailing address:
  • Phone: 307-347-5810
  • Fax: 307-347-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number270
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: