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General NPI Number Information
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NPI Number | 1104883461
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Entity Type | Organization
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Legal Business Name | THUNDER BASIN ORTHOPAEDICS AND SPORTS MEDICINE PC
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 111 S 5TH ST
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City | DOUGLAS
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State | WY
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Zip | 82633-2434
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Country | US
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Telephone | 307-358-6200
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Fax | 307-358-3748
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Provider Business Mailing Address
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Address Line | PO BOX 688
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City | DOUGLAS
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State | WY
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Zip | 82633-0688
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Country | US
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Telephone | 307-358-6200
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Fax | 307-358-3748
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK G MURPHY
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Credential | MD
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Telephone | 307-358-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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