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NPI Code Detail

MEDICARE: JEAN STACHON M.D.

MEDICARE: JEAN STACHON M.D.
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
1207Q00000XFamily Medicine Physician3841AWY

General Provider Information

NPI Number : 1992890933
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN STACHON M.D.
Provider Business Mailing Address
First Line : 1208 HILLTOP DR STE 105
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82901-5858
Country : US
Telephone Number : 307-382-8644
Fax Number : 307-382-8645
Provider Business Practice Location Address
First Line : 1208 HILLTOP DR STE 105
Second Line :
City : ROCK SPRINGS
State : WY
Zip : 82901-5858
Country : US
Telephone Number : 307-382-8644
Fax Number : 307-382-8645
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2006
Last Update Date : 08/16/2010

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Directions to “ JEAN STACHON M.D.” Practice Location

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