| Doctor Name: | DAVID THATCH |
| NPI Number: | 1205235330 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MT |
| License Number: | |
| Business Practice Address: | 29 Black Coal Drive Fort Washakie, WY - 82514 |
| Business Phone Number: | 3073327300 |
| Business Fax Number: | 3073327514 |
| Mailing Address: | 29 Black Coal Dr, FT. WASHAKIE |
| State: | WY |
| Postal Code: | 82514 |
| Phone Number: | 3073327300 |
| Fax Number: | 3073327514 |
| NPI Enumeration Date: | 08/14/2014 |
| NPI Last Update Date: | 08/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 246QM0706X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Spec/Tech, Pathology |
| Taxonomy Specialization: | Medical Technologist |
| Taxonomy Definition: | |