Individual
JASON CUSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1263 N 15TH ST, LARAMIE, WY 82072-2343
(307) 745-8915
Mailing address
1263 N 15TH ST, LARAMIE, WY 82072-2343
(307) 745-8915
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/21/2010
Last updated
01/21/2010
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