Basic Information
| Provider Information | |||||||||
| NPI: | 1306898705 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 MCCOLLUM DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820705151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077456065 | ||||||||
| FaxNumber: | 3077454936 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 N. 30TH ST. | ||||||||
| Address2: | |||||||||
| City: | LARAMIE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820725140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3077422141 | ||||||||
| FaxNumber: | 3077422150 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 09/07/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4221 | AK | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 4221 | AK | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 1336 | WY | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 1336 | WY | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00133765 | 01 | AK | PRICE RAILROAD MCR# | OTHER | 020257499 | 01 | AK | GROUPS ENERGY EMP# | OTHER | 193975000 | 01 | AK | GROUPS FED DOL# | OTHER | MD0638 | 05 | AK | MEDICAID | CI9459 | 01 | AK | GROUPS RAILROAD MCR# | OTHER | MDG417 | 05 | AK | MEDICAID |