Individual
MANSOUR ELTAHER KHADDR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1204 HILLTOP DR STE 106, ROCK SPRINGS, WY 82901-5861
(307) 522-5555
(888) 819-5155
Mailing address
1204 HILLTOP DR STE 106, ROCK SPRINGS, WY 82901-5861
(307) 522-5555
(888) 819-5155
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
12748A
WY
207RI0011X
Interventional Cardiology Physician
12748A
WY
Other
Enumeration date
04/08/2012
Last updated
03/25/2024
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