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General NPI Number Information
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NPI Number | 1932348414
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Entity Type | Organization
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Legal Business Name | COWBOY KIDS PEDIATRICS
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Dates
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Enumeration Date | 02/06/2009
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 5237 HHR RANCH RD STE 1
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City | WILSON
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State | WY
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Zip | 83014-9220
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Country | US
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Telephone | 307-203-5035
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Fax | 949-655-6058
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Provider Business Mailing Address
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Address Line | PO BOX 4755
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City | JACKSON
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State | WY
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Zip | 83001-4755
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Country | US
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Telephone | 307-734-0242
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Fax | 307-734-8477
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | RUTH ANNE SMREKAR TOMLINSON
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Credential | M.D.
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Telephone | 307-699-0932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 7622A
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License Number State | WY
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