Individual
SHIRL DOUGLAS GEORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 E BROADWAY AVE STE 108, JACKSON, WY 83001-8640
(307) 734-1313
(307) 734-0314
Mailing address
PO BOX 14230, JACKSON, WY 83002-4230
(307) 734-1313
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
6199A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114060400
—
WY
Enumeration date
10/20/2006
Last updated
09/17/2012
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