| NPI | 1467671867 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY FISHER President 307-514-9901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WY 113) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WY 113) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-09-03 |