Individual
MR. JACK VERNON RICHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3500 HAT SIX ROAD, CASPER, WY 82609
(307) 265-7881
Mailing address
P.O. BOX 186, EVANSVILLE, WY 82636-0186
(307) 265-7881
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2274V
WY
Other
Enumeration date
04/28/2009
Last updated
04/28/2009
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