Basic Information
| Provider Information | |||||||||
| NPI: | 1811401821 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COWBOY MEDICAL GROUP PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1125 CHARLES AVE | ||||||||
| Address2: | |||||||||
| City: | WORLAND | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824014021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073472449 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1125 CHARLES AVE | ||||||||
| Address2: | |||||||||
| City: | WORLAND | ||||||||
| State: | WY | ||||||||
| PostalCode: | 824014021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3073472449 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2017 | ||||||||
| LastUpdateDate: | 11/29/2017 | ||||||||
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| AuthorizedOfficialLastName: | WEYER | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/ MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3078645534 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.