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Organization
NORTHEAST WYOMING PATHOLOGY, P.C.
Active
Organization
NORTHEAST WYOMING PATHOLOGY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM B WOODWARD JR. MD (PRESIDENT)
(817) 731-7771
Entity
Organization
Contact information
Practice address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(817) 731-7771
(817) 731-7774
Mailing address
501 S BURMA AVE, GILLETTE, WY 82716-3426
(817) 731-7771
(817) 731-7774
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
5471A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04744001
BCBS
WY
05
—
111289900
—
WY
01
—
220032568
MEDICARE RR
WY
Enumeration date
06/04/2007
Last updated
05/01/2008
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