Organization
UPSTREAM HEALTH SERVICES, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL DUANE TRACY M.D. (CO-OWNER)
(307) 254-0801
Entity
Organization
Contact information
Practice address
250 N EVARTS ST, POWELL, WY 82435-2718
(307) 254-0801
Mailing address
250 N EVARTS ST, POWELL, WY 82435-2718
(307) 254-0801
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
6460A
WY
207R00000X
Internal Medicine Physician
6739A
WY
208000000X
Pediatrics Physician
6739A
WY
Other
Enumeration date
07/24/2015
Last updated
07/24/2015
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