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NPI Code Detail

MEDICARE: PHILLIP O TIGERT PAC

MEDICARE: PHILLIP O TIGERT PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant0364SD

General Provider Information

NPI Number : 1689670267
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHILLIP O TIGERT PAC
Provider Business Mailing Address
First Line : 111 S 5TH ST
Second Line :
City : DOUGLAS
State : WY
Zip : 82633-2434
Country : US
Telephone Number : 307-358-7300
Fax Number :
Provider Business Practice Location Address
First Line : 111 S 5TH ST
Second Line :
City : DOUGLAS
State : WY
Zip : 82633-2434
Country : US
Telephone Number : 307-358-7300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2005
Last Update Date : 12/19/2016

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Directions to “ PHILLIP O TIGERT PAC” Practice Location

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