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General NPI Number Information
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NPI Number | 1922953405
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PATHOLOGY OF WYOMING
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Dates
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Enumeration Date | 03/02/2026
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Last Update Date | 03/02/2026
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Provider Practice Location Address
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Address Line | 111 SOUTH JEFFERSON STREET
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City | CASPER
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State | WY
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Zip | 82601
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Country | US
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Telephone | 877-697-2447
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 421565
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City | HOUSTON
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State | TX
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Zip | 77242-1565
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | HOWARD MARTIN III
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Credential | MD
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Telephone | 877-697-2447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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