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General NPI Number Information
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NPI Number | 1669674396
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Entity Type | Organization
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Legal Business Name | NORTHEAST WYOMING PATHOLOGY, P.C.
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 501 S BURMA AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3426
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Country | US
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Telephone | 817-731-7771
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Fax | 817-731-7774
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Provider Business Mailing Address
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Address Line | 501 S BURMA AVE
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City | GILLETTE
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State | WY
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Zip | 82716-3426
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Country | US
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Telephone | 817-731-7771
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Fax | 817-731-7774
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM B WOODWARD JR.
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Credential | MD
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Telephone | 817-731-7771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 5471A
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License Number State | WY
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