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General NPI Number Information
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NPI Number | 1922282615
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Entity Type | Organization
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Legal Business Name | GERARD P COURNOYER, MD
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Dates
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Enumeration Date | 12/18/2007
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 1008 SPRUCEWOOD DR
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4485
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Country | US
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Telephone | 307-362-8834
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Fax | 307-362-8834
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Provider Business Mailing Address
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Address Line | 1008 SPRUCEWOOD DR
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4485
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Country | US
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Telephone | 307-362-8834
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Fax | 307-362-8834
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Authorized Official
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Title or Position | OWNER
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Name | GERARD P COURNOYER
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Credential | MD
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Telephone | 307-362-8834
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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 | 5467A
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License Number State | WY
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