=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366441131
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRIS ALLEN CANFIELD MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/14/2005
-----------------------------------------------------
Last Update Date | 02/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 S MEDICAL ARTS CT STE B
-----------------------------------------------------
City | GILLETTE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82716-3372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-682-7500
-----------------------------------------------------
Fax | 307-682-7585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 967
-----------------------------------------------------
City | GILLETTE
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82717-0967
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-682-7500
-----------------------------------------------------
Fax | 307-682-7585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 04-32083
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 8398A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------