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General NPI Number Information
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NPI Number | 1659369650
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Entity Type | Individual
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Provider Name | JERRY S JARRARD MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 07/15/2019
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Provider Practice Location Address
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Address Line | 2002 W SUNSET DR SUITE 2
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City | RIVERTON
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State | WY
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Zip | 82501-2283
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Country | US
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Telephone | 307-463-7160
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Fax | 307-463-7159
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Provider Business Mailing Address
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Address Line | 5000 BLACKMORE RD
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City | CASPER
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State | WY
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Zip | 82609-3345
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Country | US
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Telephone | 307-233-6000
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Fax | 307-233-6089
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 4167A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 4167A
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License Number State | WY
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