Doctor Name: | SANDRA SLADE MOSSBROOK |
NPI Number: | 1134297310 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 3296A |
Business Practice Address: | 8204 State Highway 789 Lander, WY - 825202941 |
Business Phone Number: | 3073356716 |
Business Fax Number: | 3073356991 |
Mailing Address: | 4251 Valley Green Circle, RIVERTON |
State: | WY |
Postal Code: | 825015453 |
Phone Number: | 3078565600 |
Fax Number: | |
NPI Enumeration Date: | 12/04/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 3296A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |