=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841298536
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASON W LLOYD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2005
-----------------------------------------------------
Last Update Date | 12/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1020 S. CONWELL STREET
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-265-8300
-----------------------------------------------------
Fax | 307-233-8230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1020 S. CONWELL STREET
-----------------------------------------------------
City | CASPER
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-265-8300
-----------------------------------------------------
Fax | 307-233-8230
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 6674A
-----------------------------------------------------
License Number State | WY
-----------------------------------------------------