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General NPI Number Information
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NPI Number | 1770198764
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Entity Type | Organization
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Legal Business Name | UNIVERSITY OF WYOMING
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 09/15/2020
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Provider Practice Location Address
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Address Line | 1522 E A ST
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City | CASPER
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State | WY
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Zip | 82601-2217
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Country | US
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Telephone | 307-233-6161
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Fax | 307-234-7032
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Provider Business Mailing Address
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Address Line | 1522 E A ST
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City | CASPER
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State | WY
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Zip | 82601-2217
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Country | US
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Telephone | 307-233-6161
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Fax | 307-234-7032
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Authorized Official
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Title or Position | CMO
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Name | BETH C ROBITAILLE
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Credential | MD
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Telephone | 307-234-6161
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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 |
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License Number State |
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