| NPI | 1255716833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL DUANE TRACY Co Owner 307-254-0801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WY 6460A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 6739A) |
| 208000000X Pediatrics (Licence: WY 6739A) | |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2015-07-24 |