Individual
LAWRENCE J DIRKSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
777 AVENUE H, POWELL, WY 82435-2260
(307) 754-2267
Mailing address
449 MOUNTAIN VIEW ST, POWELL, WY 82435-2232
(307) 754-4559
(307) 754-7733
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
5566A
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012064
—
MT
01
—
306684
BLUE CROSS BLUE SHIELD
WY
Enumeration date
10/17/2005
Last updated
07/08/2007
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