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General NPI Number Information
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NPI Number | 1740312495
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Entity Type | Organization
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Legal Business Name | FREMONT RADIOLOGY, PC
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1001 W MAIN ST
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City | RIVERTON
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State | WY
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Zip | 82501-3230
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Country | US
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Telephone | 307-856-6530
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 W MAIN ST
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City | RIVERTON
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State | WY
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Zip | 82501-3230
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Country | US
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Telephone | 307-856-6530
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | VALERIE LAWRENCE
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Credential |
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Telephone | 307-856-6530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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