Individual
MARK O RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
720 LINDSAY LN, STE C, CODY, WY 82414-4103
(307) 578-1955
(307) 578-1957
Mailing address
720 LINDSAY LN, STE C, CODY, WY 82414-4103
(307) 578-1955
(307) 578-1957
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
140
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
315013
BLUE CROSS BLUE SHIELD
WY
01
—
612315900
OWCP
WY
01
—
753143209
WIN HEALTH
WY
Enumeration date
09/26/2006
Last updated
10/07/2008
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