Organization
GOOSE CREEK PEDIATRICS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY I BOWERS MD (OWNER)
(307) 672-7700
Entity
Organization
Contact information
Practice address
1701 W 5TH ST, STE A, SHERIDAN, WY 82801-2748
(307) 672-7700
Mailing address
1701 W 5TH ST, STE A, SHERIDAN, WY 82801-2748
(307) 672-7700
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8820875
MONTANA MEDICAID
WY
Enumeration date
06/21/2006
Last updated
08/22/2020
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