Individual
ROWAN E TICHENOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1119 E 3RD ST, CASPER, WY 82601-2905
(307) 266-2772
(307) 266-2076
Mailing address
1119 E 3RD ST, CASPER, WY 82601-2905
(307) 266-2772
(307) 266-2076
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
2634A
WY
207ND0900X
Dermatopathology Physician
2634A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
070011534
RR MEDICARE
—
05
—
106641200
—
WY
Enumeration date
07/13/2005
Last updated
07/29/2014
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