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Organization
DAZA MEDICAL CONSULTING SERVICE PC
Active
Organization
DAZA MEDICAL CONSULTING SERVICE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI LABRECQUE (ACCTS MGR)
(702) 453-3799
Entity
Organization
Contact information
Practice address
400 S 15TH STREET, WORLAND, WY 82401-3531
(307) 347-3221
Mailing address
2425 SHADOW RIDGE DRIVE, GERING, NE 69341
(702) 453-3799
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
8947A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8947A
WY LIC
WY
Enumeration date
09/13/2012
Last updated
09/13/2012
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