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General NPI Number Information
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NPI Number | 1932231081
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Entity Type | Organization
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Legal Business Name | ROWAN E TICHENOR MD PC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 10/03/2007
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Provider Practice Location Address
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Address Line | 1119 E 3RD ST
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City | CASPER
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State | WY
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Zip | 82601-2905
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Country | US
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Telephone | 307-266-2772
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Fax | 307-266-2076
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Provider Business Mailing Address
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Address Line | 1119 E 3RD ST
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City | CASPER
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State | WY
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Zip | 82601-2905
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Country | US
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Telephone | 307-266-2772
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Fax | 307-266-2076
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROWAN E TICHENOR
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Credential | MD
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Telephone | 307-266-2772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | 2634A
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2634A
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License Number State | WY
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