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General NPI Number Information
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NPI Number | 1407892300
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Entity Type | Organization
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Legal Business Name | GOOSE CREEK PEDIATRICS PC
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1701 W 5TH ST STE A
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City | SHERIDAN
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State | WY
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Zip | 82801-2748
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Country | US
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Telephone | 307-672-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 W 5TH ST STE A
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City | SHERIDAN
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State | WY
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Zip | 82801-2748
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Country | US
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Telephone | 307-672-7700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY I BOWERS
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Credential | MD
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Telephone | 307-672-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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