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General NPI Number Information
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NPI Number | 1265047773
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Entity Type | Organization
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Legal Business Name | BACKCOUNTRY DOX, LLC
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Dates
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Enumeration Date | 09/11/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 1320 MORADO DR
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City | CASPER
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State | WY
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Zip | 82609
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Country | US
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Telephone | 307-258-6618
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Fax | 877-850-2332
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Provider Business Mailing Address
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Address Line | 301 THELMA DR # 440
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City | CASPER
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State | WY
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Zip | 82609-2325
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Country | US
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Telephone | 307-258-6618
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Fax | 877-850-2332
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. NATHAN KER
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Credential | DO
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Telephone | 307-258-6618
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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